Compositions comprising cardiac stem cells overexpressing specific micrornas and methods of their use in repairing damaged myocardium

ABSTRACT

The invention provides compositions comprising modified stem cells containing a transgene that affects the expression of at least one gene that inhibits or promotes cardiomyogenesis. In particular, the invention discloses compositions comprising cardiac stem cells, wherein said cardiac stem cells comprise a transgene encoding a microRNA. The compositions of the invention find use in the treatment of cardiovascular disorders, such as myocardial infarction. Methods of repairing damaged myocardium in a subject using the modified stem cells are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/059,936, filed Jun. 9, 2008, which is herein incorporated byreference in its entirety.

FIELD OF THE INVENTION

The present invention relates generally to the field of cardiology, andmore particularly relates to compositions of cardiac stem cellsoverexpressing specific microRNAs and their use for promoting stem celldifferentiation. The invention also relates to methods of using thecompositions comprising microRNA-overexpressing cardiac stem cells forrepairing damaged myocardium.

BACKGROUND OF THE INVENTION

Cardiovascular disease is a major health risk throughout theindustrialized world. An estimated 80.7 million Americans suffer fromone or more types of cardiovascular disease, including high bloodpressure, coronary heart disease, heart failure, and stroke (HeartDisease and Stroke Statistics, American Heart Association, 2008).Cardiovascular disease was the cause of 57 percent of the deaths in2004, and every year since 1900 (except 1918), cardiovascular diseaseaccounts for more deaths than any other single cause or group of causesin the United States.

One of the most well-known types of cardiovascular disease is myocardialinfarction (MI), commonly known as a heart attack. Estimates for 2005show that 8.1 million people in the United States suffer from MI (HeartDisease and Stroke Statistics, American Heart Association, 2008). MI iscaused by a sudden and sustained lack of blood flow to an area of theheart, typically caused by narrowing of a coronary artery. Withoutadequate blood supply, the tissue becomes ischemic, leading to the deathof myocytes and vascular structures. This area of necrotic tissue isreferred to as the infarct site, and will eventually become scar tissue.Survival is dependent on the size of this infarct site, with theprobability of recovery decreasing with increasing infarct size. Forexample, in humans, an infarct of 46% or more of the left ventricletriggers irreversible cardiogenic shock and death.

Myocardial regeneration involves the replacement of cells lost followinginjury, such as an ischemic injury. Damage creates a barrier torestitutio ad integrum and promotes the initiation of a healing processthat leads to scar formation (Leri et al. 2005). However, the scar doesnot possess the biochemical, physical and functional properties of theoriginal tissue. Effective cardiac repair necessitates creatingmyocardium de novo that closely resembles the morphology of the normaladult heart.

Successful regeneration of myocardial tissue after acute infarction hasbeen achieved by employing cardiac stem cells (CSCs). Administration ofautologous CSCs to the damaged myocardium or local activation ofresident CSCs by intramyocardial administration of growth factorsresults in a significant recovery of ventricular muscle mass. However,the regenerated myocytes are small and have the characteristics offetal-neonatal cells (Beltrami et al., 2003; Urbanek et al., 2005; Linkeet al., 2005; and Bearzi et al. 2007). Thus, one of the major problemsin cardiac repair is the lack of maturation of the newly formedcardiomyocytes. This problem is even more apparent when bone marrowprogenitor cells (BMPCs) are employed for myocardial repair.Mobilization of BMPCs with cytokines or direct implantation of BMPCs inproximity of an infarct typically shows BMPC transdifferentiation withthe generation of a large number of immature cardiomyocytes.Unfortunately, these cells rarely increase in size over time and fail toattain the properties of fully developed adult myocytes.

Thus, it is desirable to develop methods of facilitating thedifferentiation of CSCs and BMPCs into fully mature cardiomyocytes. Suchmethods would significantly improve stem cell-mediated treatment ofmyocardial infarctions and provide new approaches to the management ofhuman heart failure.

SUMMARY OF THE INVENTION

The present invention provides compositions of modified stem cells thatare capable of differentiating into cardiomyocytes that attain the fullymature, adult phenotype. Such compositions are useful in the treatmentof various cardiovascular disorders that result in damaged heart tissue.Modified stem cells of the invention comprise a transgene that affectsthe expression of at least one gene that inhibits or promotescardiomyogenesis.

The modified stem cells of the invention are adult cardiac stem cells oradult bone marrow progenitor cells that comprise a transgene.Preferably, the stem cells of the invention are lineage negative andc-kit positive. The stem cells may be human stem cells.

In particular, the present invention provides pharmaceuticalcompositions comprising an effective amount of modified stem cells and apharmaceutically acceptable carrier. In one embodiment, the compositioncomprises cardiac stem cells and a pharmaceutically acceptable carrier,wherein said cardiac stem cells comprise a transgene. In anotherembodiment, said transgene encodes a microRNA. The microRNA may be amicroRNA that is abundantly expressed in adult cardiomyocytes. In apreferred embodiment, the transgene encodes miR-499.

In another embodiment, the cardiac stem cells comprise a transgene thatencodes an inhibitory RNA molecule, such as siRNA, shRNA, or antisense.The inhibitory RNA molecule preferably comprises a nucleic acid sequencethat is substantially complementary to a polynucleotide sequenceencoding a protein that inhibits cardiomyogenesis. In some embodiments,the inhibitory RNA molecule targets a polynucleotide sequence encoding aprotein selected from the group consisting of Sox5, Sox6 and Rod1.

The present invention also contemplates pharmaceutical compositionscomprising modified cardiac stem cells and vascular progenitor cells.Vascular progenitor cells (VPCs) are a specific subset of cardiac stemcells that are c-kit and flk1 positive. VPCs may differentiate intoendothelial cells and smooth muscles, thereby forming new vascularstructures.

The invention also provides methods for regenerating damaged myocardiumin a subject in need thereof. In one embodiment, the method comprisesadministering a pharmaceutical composition of the invention to an areaof damaged myocardium in the subject, wherein the cardiac stem cellsdifferentiate into mature, functional cardiomyocytes followingadministration, thereby regenerating the damaged myocardium. Inpreferred embodiments, the regenerated myocardium exhibits thefunctional characteristics of adult myocardium. In another preferredembodiment, the cardiac stem cells are autologous or isolated from thesame subject to which they are re-administered.

In another embodiment, the method comprises extracting cardiac stemcells from the subject; incorporating a transgene into said extractedcardiac stem cells, wherein said transgene encodes a microRNA; andadministering the cardiac stem cells comprising the transgene to an areaof damaged myocardium in the subject, wherein the cardiac stem cellsdifferentiate into mature, functional cardiomyocytes followingadministration, thereby regenerating the damaged myocardium. In apreferred embodiment, the cardiac stem cells overexpress miR-499. Insome embodiments, the method further comprises administering vascularprogenitor cells to the area of damaged myocardium.

In another embodiment of the invention, the method comprisesadministering unmodified cardiac stem cells to an area of damagedmyocardium in a subject in need thereof, wherein the cardiac stem cellsdifferentiate into myocytes, smooth muscle cells, and endothelial cellsafter their administration, thereby regenerating the damaged myocardium;and administering a transgene encoding a microRNA to the area ofregenerated myocardium, wherein the regenerated myocardium exhibits thefunctional characteristics of adult myocardium following transgeneadministration.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. MiR hybridization array comparing the level of expression ofdistinct miRs in CSCs and myocytes obtained from the rat heart.

FIG. 2. A. Quantitative RT-PCR for miR-499. Neonatal myocytes have asignificantly higher level of expression of miR-499 than human cardiacstem cells (hCSCs). B. The Myh7b gene has a low degree of homology withβ-MHC and contains Nkx2.5 consensus sites in its putative promoterregion.

FIG. 3. One, two and three miR-499 binding sites are present in the3′-UTR of human Sox5 (red), Rod1 (blue) and Sox6 (green) mRNA,respectively. Black sequences correspond to mature miR-499.

FIG. 4. A. 3T3 cells were co-transfected with pre-miR-499 and reporterplasmids in which the luciferase coding sequence was placed under thecontrol of the CMV promoter. The 3′-UTR of Rod1 and Sox6 genes werecloned downstream of luciferase. The presence of miR-499 induced adecrease in luciferase activity in the transfected cells. B, C.Quantitative RT-PCR for the expression of miR-499 in 3T3 transfectedwith an expression plasmid carrying miR-499. With respect to 3T3 cellstransfected with blank plasmids, the quantity of miR-499 increased5,500-fold. Small nucleolar RNA (sno-412) was employed fornormalization. These cells were employed for the reporter assay in panelD. D. miR-499 overexpressing 3T3 cells were transfected with reporterplasmids in which the 3′-UTR of Rod1 and Sox6 genes were cloneddownstream of luciferase. Increasing amounts of miR-499 expressionplasmid were used for transfection (0-0.8 μg). The decrease inluciferase activity paralleled the increase in miR-499 expression.Luciferase only denotes 3T3 cells transfected with a reporter plasmidwithout 3′-UTR of Rod1 and Sox6 genes.

FIG. 5. A. Quantitative RT-PCR for Rod1 and Sox6 transcripts in CSCs andmyocytes obtained from the rat heart. B. Western blotting for Rod1 andSox6 proteins in rat CSCs and myocytes. GAPDH was used fornormalization. C. The expression of Rod1 and Sox6 was measuredquantitatively by immunocytochemistry in rat CSCs and myocytes. Thefraction of cells positive for the two proteins is shown. D.Quantitative RT-PCR for Sox5, Sox6 and Rod1 transcripts in hCSCs andhuman myocardium.

FIG. 6. A. Quantitative RT-PCR for miR-499 in C2C12 myoblasts and hCSCs.The quantity of miR-499 is higher in C2C12 myoblasts than hCSCs. B, C.After 24 hours, miR-499 (red) was present in hCSCs (c-kit, green)co-cultured with C2C12. Connexin 43 (white) was expressed at theinterface between the two cell types.

FIG. 7. Effect of the translocated miR-499 on the 3′-UTR of the Sox6gene measured by the luciferase reporter assay. This function of miR-499was abolished when co-cultures were treated with the gap junctioninhibitor α-GA.

FIG. 8. A-C. Human myocardial niche containing 14 c-kit positive CSCs(A, green). Arrows delimit the areas shown in panels B and C. Connexin43 and N-cadherin are expressed between CSCs and between CSCs andfibroblasts (procollagen, blue) and myocytes (α-sarcomeric actin, red).D. Area of myocardial regeneration in the rat heart following theinjection of human CSCs. Newly formed Alu-positive human myocytes areinterconnected with Alu-negative rat myocytes by connexin 43.

FIG. 9. miR-499 and CSC proliferation and differentiation. A, B.Quantitative RT-PCR of miR-499 in human myocardium and hCSCsoverexpressing miR-499. Non-transfected hCSCs (control) and hCSCstransfected with an empty vector (blank) were employed as control.Reaction was normalized with human small nucleolar RNA, RNU44. C. BrdUincorporation is higher in hCSCs transfected with an empty vector(Blank) than in hCSCs overexpressing miR-499. D. Quantitative RT-PCR ofNkx2.5 and Mef2C mRNA in hCSCs transfected with miR-499 expressionvector. E. Downregulation of Rod1 and Sox6 transcripts following CSCtransfection with Rod1-siRNA and Sox6-siRNA, respectively. F. Activationof differentiation of CSCs by Rod1-siRNA and Sox6-siRNA.

DETAILED DESCRIPTION OF THE INVENTION

As used herein, “autologous” refers to something that is derived ortransferred from the same individual's body (i.e., autologous blooddonation; an autologous bone marrow transplant).

As used herein, “allogenic” refers to something that is geneticallydifferent although belonging to or obtained from the same species (e.g.,allogeneic tissue grafts or organ transplants).

As used herein, “stem cells” are used interchangeably with “progenitorcells” and refer to cells that have the ability to renew themselvesthrough mitosis as well as differentiate into various specialized celltypes. The stem cells used in the invention are somatic stem cells, suchas bone marrow or cardiac stem cells or progenitor cells. “Vascularprogenitor cells” or VPCs are a subset of adult cardiac stem cells thatare c-kit positive and flk1 positive, which generate predominantlyendothelial cells and smooth muscle cells. “Myocyte progenitor cells” orMPCs are a subset of adult cardiac stem cells that are c-kit positiveand flk1 negative, which generate cardiomyocytes predominantly.

As used herein, “adult” stem cells refers to stem cells that are notembryonic in origin nor derived from embryos or fetal tissue.

Stem cells employed in the invention are advantageously selected to belineage negative. The term “lineage negative” is known to one skilled inthe art as meaning the cell does not express antigens characteristic ofspecific cell lineages. And, it is advantageous that the lineagenegative stem cells are selected to be c-kit positive. The term “c-kit”is known to one skilled in the art as being a receptor which is known tobe present on the surface of stem cells, and which is routinely utilizedin the process of identifying and separating stem cells from othersurrounding cells.

As used herein, the term “transgene” refers to a polynucleotide sequencethat is not endogenously expressed in a host cell. The polynucleotidesequence may produce RNA or protein upon introduction into the hostcell. Alternatively, the polynucleotide sequence may alter the normalgene expression of the host cell into which it is introduced.

As used herein, the term “cytokine” is used interchangeably with “growthfactor” and refers to peptides or proteins that bind receptors on cellsurfaces and initiate signaling cascades thus influencing cellularprocesses. The terms “cytokine” and “growth factor” encompass functionalvariants of the native cytokine or growth factor. A functional variantof the cytokine or growth factor would retain the ability to activateits corresponding receptor. Variants can include amino acidsubstitutions, insertions, deletions, alternative splice variants, orfragments of the native protein. The term “variant” with respect to apolypeptide refers to an amino acid sequence that is altered by one ormore amino acids with respect to a reference sequence. The variant canhave “conservative” changes, wherein a substituted amino acid hassimilar structural or chemical properties, e.g., replacement of leucinewith isoleucine. Alternatively, a variant can have “nonconservative”changes, e.g., replacement of a glycine with a tryptophan. Analogousminor variations can also include amino acid deletion or insertion, orboth. Guidance in determining which amino acid residues can besubstituted, inserted, or deleted without eliminating biologicalactivity can be found using computer programs well known in the art, forexample, DNASTAR software.

As used herein “damaged myocardium” refers to myocardial cells whichhave been exposed to ischemic conditions. These ischemic conditions maybe caused by a myocardial infarction, or other cardiovascular disease orrelated complaint. The lack of oxygen causes the death of the cells inthe surrounding area, leaving an infarct, which will eventually scar.

As used herein, “patient” or “subject” may encompass any vertebrateincluding but not limited to humans, mammals, reptiles, amphibians andfish. However, advantageously, the patient or subject is a mammal suchas a human, or a mammal such as a domesticated mammal, e.g., dog, cat,horse, and the like, or production mammal, e.g., cow, sheep, pig, andthe like.

The pharmaceutical compositions of the present invention may be used astherapeutic agents—i.e. in therapy applications. As herein, the terms“treatment” and “therapy” include curative effects, alleviation effects,and prophylactic effects. In certain embodiments, a therapeuticallyeffective dose of progenitor cells is applied, delivered, oradministered to the heart or implanted into the heart. An effective doseor amount is an amount sufficient to effect a beneficial or desiredclinical result. Said dose could be administered in one or moreadministrations.

Mention is made of the following related pending patent applications:

U.S. Application Publication No. 2003/0054973, filed Jun. 5, 2002, whichis herein incorporated by reference in its entirety, discloses methods,compositions, and kits for repairing damaged myocardium and/ormyocardial cells including the administration cytokines.

U.S. Application Publication No. 2006/0239983, filed Feb. 16, 2006,which is herein incorporated by reference in its entirety, disclosesmethods, compositions, and kits for repairing damaged myocardium and/ormyocardial cells including the administration of cytokines and/or adultstem cells as well as methods and compositions for the development oflarge arteries and vessels. The application also discloses methods andmedia for the growth, expansion, and activation of human cardiac stemcells.

U.S. Provisional Application No. 60/991,515, filed Nov. 30, 2007, whichis herein incorporated by reference in its entirety, disclosescompositions comprising vascular progenitor cells (VPCs) and myocyteprogenitor cells (MPCs), both of which are distinct subsets of adultcardiac stem cells. The application also discloses methods of using thedifferent compositions for repairing damaged myocardium and generatingcoronary vasculature.

The adult heart is largely composed of terminally differentiatedmyocytes. Damaged and old units of this highly specialized compartmentof contracting cells are constantly replaced by new younger elements.The heart is, in fact, a dynamic organ where myocyte death and growthare tightly regulated to maintain physiologic homeostasis (Anversa etal., 1998; Anversa et al., 2002; and Anversa et al., 2006). Mitosis andcytokinesis have been recognized mostly in small poorly differentiatedcells with a thin sub-sarcolemmal halo of myofibrils (Kajstura et al.,1998; Beltrami et al., 2001; and Limana et al., 2002). Typically, thesedividing myocytes are less than 150 μm² in cross-sectional area anddisplay telomerase activity (Urbanek et al., 2003; and Urbanek et al.,2005a). The observation that cycling myocytes are smaller than maturemyocytes suggest that newly formed cells do not derive from pre-existingmyocytes but from activation, replication and differentiation ofresident cardiac progenitor cells (CPCs), also referred to as cardiacstem cells (CSCs) (Beltrami et al., 2003; Oh et al., 2003; Pfister etal., 2005; Urbanek et al., 2005b; Linke et al., 2005; Smith et al.,2007; and Bearzi et al., 2007). Thus, the heart contains two groups ofmyocytes: a large fraction of terminally differentiated cells and asmall fraction of dividing cells. The latter is consistent with thepresence of a compartment of amplifying myocytes derived from theactivation and growth of CSCs.

When a stem cell divides, two daughter cells are formed; they maymaintain stem cell properties or become early committed amplifying cells(Götz and Huttner, 2005; and Morrison and Kimble, 2006). Transitamplifying cells proliferate and simultaneously differentiate (Watt,1998; Jones and Watt, 1993; Watt and Hogan, 2000; Taylor et al., 2000;and Wright, 2000). Telomerase activity is one of the criticaldeterminants of the number of rounds of division and rate ofdifferentiation of amplifying cells (Lansdorp, 2005; and Flores et al.,2006). When telomerase activity is downregulated, cell replication isattenuated and cell maturation takes place leading to the acquisition ofthe adult phenotype. In the intact heart, the loss of stemness isaccompanied by lineage commitment and the generation of terminallydifferentiated cardiomyocytes. However, in spite of this remarkablegrowth reserve, CSCs do not behave in a similar manner followingextensive myocardial injury; spontaneous (Beltrami et al., 2001; Urbaneket al., 2003; and Urbanek et al., 2005a) or induced (Beltrami et al.,2003; Urbanek et al., 2005b; Linke et al., 2005; and Bearzi et al., 20079, 12, 13, 15) myocardial regeneration does not recapitulate tissuehomeostasis failing to restore the structural and functional integrityof the organ.

Local activation of resident cardiac stem cells (CSCs) by growth factorsacutely after infarction results in a significant recovery ofventricular muscle mass. However, only 20% of the regenerated myocytesacquire the adult phenotype over a period of 4 months while the vastmajority of cells display fetal-neonatal characteristics. Similarly, theintramyocardial injection of CSCs induces a substantial restoration ofthe infarct but, also in this case, the newly formed myocytes are smalland resemble fetal-neonatal cells. In contrast, the occasional migrationof CSCs or bone marrow progenitor cells (BMPCs) from the border zone tothe remote myocardium results in the formation of myocytes which areindistinguishable from the preexisting adjacent cardiomyocytes.Therefore, the phenotype and organization of regenerated myocytes in theinfarcted region differ strikingly from those of newly formed myocyteslocated in the distant non-infarcted myocardium. Efficient cardiacrepair requires that the regenerated myocardium closely resemble themorphology and function of the mature adult heart. Thus, CSCs that candifferentiate into fully mature, functional cardiomyocytes will greatlyimprove the repair of damaged or infarcted myocardial tissue.

The inventors of the present invention have discovered methods offacilitating the differentiation of CSCs into cardiomyocytes that canachieve the fully mature, adult phenotype. Accordingly, the presentinvention provides compositions comprising modified CSCs that have theability to generate mature, functional cardioymyocytes, and methods ofusing the inventive compositions to repair damaged myocardium in asubject in need thereof.

The inventors have surprisingly found that regulating a specific subsetof genes in isolated CSCs can promote the differentiation of the CSCsinto cardiomyocytes. Moreover, the differentiated cardiomyocytes areable to achieve the mature phenotype of adult cardiomyocytes unlikecardiomyocytes produced from unmodified or natural CSCs. Thus, thepresent invention provides compositions comprising “modified CSCs” thathave the ability to give rise to fully mature, functionalcardiomyocytes. “Modified CSCs”, as used herein, refers to CSCscomprising a transgene, which affects the expression of at least onegene that inhibits or promotes cardiomyogenesis.

The present invention is related to modified adult stem cells orprogenitor cells, wherein the stem cells comprise a transgene.Preferably the adult stem cells are cardiac stem cells (CSCs) or bonemarrow progenitor cells (BMPCs). In some embodiments, the stem cells arehuman stem cells. In preferred embodiments, the stem cells are humancardiac stem cells. Methods of isolating adult stem cells are known inthe art. Stem cells may be isolated from tissue specimens, such asmyocardium or bone marrow, obtained from a subject or patient. By way ofexample, the tissue specimens may be minced and placed in appropriateculture medium. Stem cells growing out from the tissue specimens can beobserved in approximately 1-2 weeks after initial culture. Atapproximately 4 weeks after the initial culture, the expanded stem cellsmay be collected by centrifugation. U.S. Patent Application PublicationNo. 2006/0239983, filed Feb. 16, 2006, which is herein incorporated byreference, describes media appropriate for culturing and expanding adultstem cells. However, one of ordinary skill in the art would be able todetermine the necessary components and modify commonly used cell culturemedia to be employed in culturing the isolated stem cells of theinvention.

It is preferable that the stem cells of the invention are lineagenegative (LinNEG). LinNEG stem cells can be isolated by various means,including but not limited to, removing lineage positive cells bycontacting the stem cell population with antibodies against lineagemarkers and subsequently isolating the antibody-bound cells by using ananti-immunoglobulin antibody conjugated to magnetic beads and abiomagnet. Alternatively, the antibody-bound lineage positive stem cellsmay be retained on a column containing beads conjugated toanti-immunoglobulin antibodies.

The LinNEG stem cells preferably express one or more stem cell surfacemarkers including c-kit, which is the receptor for stem cell factor, andmultidrug resistance-1 (MDR1), which is a P-glycoprotein capable ofextruding dyes, toxic substances and drugs from the cell. Positiveselection methods for isolating a population of LinNEG stem cellsexpressing any one of these surface markers are well known to theskilled artisan. Examples of possible methods include, but are notlimited to, various types of cell sorting, such as fluorescenceactivated cell sorting (FACS) and magnetic cell sorting as well asmodified forms of affinity chromatography. In a preferred embodiment,the LinNEG stem cells are c-kit positive. In some embodiments, thecardiac stem cells may be further separated into vascular progenitorcells (VPCs) and myocyte progenitor cells (MPCs). VPCs are a subset ofCSCs that co-express c-kit and flk1, and differentiate predominantlyinto endothelial cells and smooth muscle cells, thereby giving rise tovascular structures. MPCs are a subset of CSCs that are c-kit positiveand flk1 negative, which generate cardiomyocytes predominantly. VPCs andMPCs are extensively described in co-pending U.S. ProvisionalApplication No. 60/991,515, filed Nov. 30, 2007, which is hereinincorporated by reference in its entirety.

The present invention provides compositions comprising modified stemcells, wherein said modified stem cells comprise a transgene. In oneembodiment, the modified CSCs comprise a transgene encoding a microRNA.MicroRNAs (miRs) are small non-coding RNAs of about 18 to about 25nucleotides in length that regulate gene expression by binding tomessenger RNA (mRNA) and inhibiting translation of the mRNA into proteinor promoting degradation of the mRNA. MiRs are derived from largerprecursor molecules generated by the transcription of non-coding genes.These precursor molecules, termed primary miRNAs (pri-miRNAs), aregenerally several thousand bases long and transcribed by RNA polymeraseII (pol II) from individual miRNA genes, from introns of protein codinggenes, or from poly-cistronic transcripts that often encode multiple,closely related miRs. Pri-miRNAs are processed in the nucleus by theRNase Drosha into about 70- to about 100-nucleotide hairpin-shapedprecursors (pre-miRNAs). Following transport to the cytoplasm, thehairpin pre-miRNA is further processed by Dicer to produce adouble-stranded miR. The mature miR strand is then incorporated into theRNA-induced silencing complex (RISC), where it associates with itstarget mRNAs by base-pair complementarity. In the relatively rare casesin which a miR base pairs perfectly with an mRNA target, it promotesmRNA degradation. More commonly, miRs form imperfect heteroduplexes withtarget mRNAs, inhibiting mRNA translation by binding to the3′-untranslated region (UTR).

In some embodiments, the CSCs comprise a transgene that encodes a miRexpressed in cardiomyocytes. Some non-limiting examples of miRs the areabundantly expressed in cardiomyocytes include miR-1, miR-499, miR-133a,miR-133b, miR-30a, miR-30b, miR-30c, miR-26a, miR-26b, miR-29a, miR-29c,let-7a, let-7b, let-7c, let-7d, and let-7f. In other embodiments, theCSCs comprise a transgene that encodes a miR that is differentiallyexpressed in cardiomyoctes and unmodified or natural CSCs. MiRs that aredifferentially expressed include, but are not limited to, miR-1,miR-499, miR-133a, and miR-133b. In a preferred embodiment, the CSCscomprise a transgene encoding miR-499. MiR-499 is encoded within the20^(th) intron of the Myh7b gene, which encodes a member of thesarcomeric myosin heavy chain (MHC) protein family. The miR-499 gene isin the same orientation as the Myh7b gene such that the two genes areco-transcribed. The Myh7b is expressed in brain, heart, skeletal muscle,and testis.

In another embodiment, the modified CSCs contain a transgene thatencodes an inhibitory RNA molecule. “Inhibitory RNA molecules” includesmall interfering RNA molecules (siRNAs), short hairpin RNA molecules(shRNAs), and antisense oligonucleotides. siRNA molecules aredouble-stranded RNAs that are about 20 to about 25 nucleotides in lengththat inhibit gene expression of a target mRNA by initiating the RNAinterference pathway. Similar to inhibition by miRs, one of the strandsof the siRNA duplex is incorporated into the RISC complex, which bindsto the target mRNA sequence and prevents translation of the mRNA orpromotes mRNA degradation. shRNAs are single-stranded RNA molecules thatcontain regions of self-complementarity such that the molecule foldsback on itself to form a double-stranded stem region and single-strandedloop region. shRNAs can also inhibit gene expression by entering the RNAinterference pathway. For both siRNAs and shRNAs, the double-strandedregions must comprise a sequence that is substantially complementary toa target polynucleotide sequence. “Substantially complementary” refersto a sequence that is sufficiently complementary to a targetpolynucleotide sequence such that RNA interference is induced. Thedouble-stranded regions of the siRNA or shRNA molecules may comprise asequence that is at least about 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%,or 99% complementary to a target polynucleotide sequence. In someembodiments, the double-stranded regions of the siRNA or shRNA moleculesmay contain sequences that are 100% complementary to the targetpolynucleotide sequence.

The inhibitory molecules may also be antisense oligonucleotides.Antisense oligonucleotides are single stranded oligonucleotides that aresubstantially complementary to a target polynucleotide sequence. Theantisense oligonucleotide inhibits gene expression by binding tocomplementary sequences in target mRNA molecules, thus preventing theprotein synthesis machinery from accessing and translating the mRNA.Preferably the antisense oligonucleotides contain one or more chemicalmodifications including, but not limited to, locked nucleic acids,2′-O-methyl, 2′-O-methoxyethyl, and 2′-fluoro sugar modifications; andone or more phosphorothioate linkages. The antisense oligonucleotide maycomprise a sequence that is greater than about 90% complementary to atarget polynucleotide sequence, such as about 91, 92, 93, 94, 95, 96,97, 98, 99, or 100% complementary. The antisense oligonucleotide may befrom about 50 nucleotides to about 500 nucleotides in length.

In some embodiments, the inhibitory RNA molecules are targeted to genesencoding proteins that inhibit differentiation of stem cells, and inparticular proteins that inhibit cardiomyogenesis. Some non-limitingexamples of proteins known to inhibit cardiomyogenesis include the SoxDfamily of proteins (e.g. Sox5 and Sox6), Wnt3a, Frz8, LRP6, p38 MAPK,Noggin, Ouabain, FOXO1, myostatin, and regulator of differentiation 1(Rod1). Other suitable target genes include genes that function topreserve “stemness” in cardiac stem cells and inhibit theirdifferentiation. Such genes include, but are not limited to SoxB1proteins, Nanog, October 4, ETS1, and YES1. Other possible target genesinclude GATA 4, LIN28B, PAK7, heterogeneous nuclear ribonucleoprotein C(hnRNP C1/C2), YBX1, POU4F2, ARID2, WTAP, ENPP2, PFTK1, argininedecarboxylase (ADC), insulin receptor substrate 2 (IRS2), myristoylatedalanine-rich protein kinase C substrate (MARCKS), mitogen-activatedprotein kinase 8 interacting protein 3 (MAPK8IP3), MAPK6, polypyrimidinetract binding protein 2 (PTBP2), CNOT6L, MYB, casein kinase 1 gamma 1(CSNK1G1), SOX11, frizzled homolog 8 (FZD8), TSPAN12, phosphodiesterase4D (PDE4D), vestigial like 2 (VGLL2), calcium channel voltage-dependentbeta 2 subunit (CACNB2), and eyes absent homolog 4 (EYA4). In preferredembodiments, CSCs comprise a transgene encoding an inhibitory RNAmolecule targeted to Sox5, Sox6, or Rod1 polynucleotide sequences.

In another embodiment of the invention, the modified CSCs contain atransgene that encodes a protein that promotes commitment to the myocytelineage. Such proteins may include, but are not limited to, Nkx2.5,MEF2C, Notch1 receptor, and the intracellular domain of the Notch 1receptor (N1ICD). It has recently been shown that activation of theNotch1 receptor on CSCs by the Jagged ligand expressed on neighboringcardiomyocytes in the mouse heart upregulates expression of Nkx2.5 andpromotes the commitment of CSCs to the myocyte lineage. Furthermore,disruption of the Notch1 signaling cascade impairs myocardialregeneration after myocardial infarction. Thus, other suitable proteinsthat may be encoded by the transgene contained within modified CSCs maybe proteins that enhance the Notch 1 signaling cascade.

The transgene may be introduced into the CSCs in various ways.Polynucleotide sequences comprising a miR sequence, an inhibitory RNAsequence, or a coding sequence may be directly transfected into isolatedCSCs using standard methods in the art. Such methods include, but arenot limited to, lipofection, DEAE-dextran-mediated transfection,microinjection, protoplast fusion, calcium phosphate precipitation,electroporation, and biolistic transformation. Alternatively, thetransgene may be expressed in CSCs from a vector. A “vector” is acomposition of matter which can be used to deliver a nucleic acid ofinterest to the interior of a cell. Numerous vectors are known in theart including, but not limited to, linear polynucleotides,polynucleotides associated with ionic or amphiphilic compounds,plasmids, and viruses. Thus, the term “vector” includes an autonomouslyreplicating plasmid or a virus. Examples of viral vectors include, butare not limited to, adenoviral vectors, adeno-associated virus vectors,retroviral vectors, lentiviral vectors and the like. An expressionconstruct can be replicated in a living cell, or it can be madesynthetically. For purposes of this application, the terms “expressionconstruct,” “expression vector,” and “vector,” are used interchangeablyto demonstrate the application of the invention in a general,illustrative sense, and are not intended to limit the invention.

In one embodiment, a vector for expressing the transgene comprises apromoter “operably linked” to the transgene. The phrase “operablylinked” or “under transcriptional control” as used herein means that thepromoter is in the correct location and orientation in relation to apolynucleotide to control the initiation of transcription by RNApolymerase and expression of the polynucleotide. Several promoters aresuitable for use in the vectors for expressing the transgene, including,but not limited to, RNA pol I promoter, RNA pol II promoter, RNA pol IIIpromoter, and cytomegalovirus (CMV) promoter. Other useful promoters arediscernible to one of ordinary skill in the art. In some embodiments,the promoter is an inducible promoter that allows one to control whenthe transgene is expressed. Suitable examples of inducible promotersinclude tetracycline-regulated promoters (tet on or tet off) andsteroid-regulated promoters derived from glucocorticoid or estrogenreceptors. Additionally, several inducible expression systems, such asthe Rheoswitch® from New England Biolabs, are commercially available andmay be used to express the transgene in isolated CSCs. Alternatively,the promoter operably linked to the transgene may be a promoter that isactivated in specific cell types and/or at particular points indevelopment. For example, the promoter may be derived from genesexpressed early in myocyte differentiation, such as Nkx2.5, Mef2C, Tbx5and myocardin.

In one embodiment of the invention, the modified CSCs comprise atransgene encoding a miR, wherein said transgene is expressed from avector comprising a promoter operably linked to said transgene.Preferably, the miR encoded by the transgene is overexpressed in theCSCs. In another embodiment, the promoter is an inducible promoter. Inanother embodiment, the vector is a lentiviral vector. In a preferredembodiment, the transgene encodes miR-499.

In another embodiment of the invention, the modified CSCs comprise atransgene encoding an inhibitory RNA molecule, wherein said transgene isexpressed from a vector comprising a promoter operably linked to saidtransgene. If the inhibitory RNA molecule is a siRNA molecule, thevector may comprise two convergent promoters such that the sense strandand the antisense strand are transcribed from the same nucleic acidsequence. In preferred embodiments, the expressed inhibitory RNAmolecules target polynucleotide sequences encoding Sox5, Sox6, or Rod1proteins.

The present invention also provides methods of regenerating damagedmyocardium in a subject in need thereof. In one embodiment, the methodcomprises administering a pharmaceutical composition to an area ofdamaged myocardium in the subject, said pharmaceutical compositioncomprising modified cardiac stem cells as described herein, wherein saidmodified cardiac stem cells differentiate into mature, functionalcardiomyocytes following administration, thereby regenerating thedamaged myocardium. “Mature cardiomyocytes” refer to cardiomyocytes thatexhibit the electrical, mechanical, and morphological characteristics ofcardiomyocytes found in the adult heart. For example, maturecardiomyocytes do not possess the T-type calcium current, are generallylarger than immature cardiomyocytes, are binucleate or multinucleate,have action potentials of shorter duration, and exhibit an increase involtage-gated potassium currents. “Functional cardiomyocytes” arecardiomyocytes that are coupled to the viable existing myocardium (e.g.through gap and adherens junctions) and contribute to the normalfunction of the adult heart. In another embodiment, the regeneratedmyocardium exhibits the functional characteristics of adult myocardium.“Functional characteristics of adult myocardium” refer to electrical,mechanical, and morphological properties found exclusively in adultmyocardium as opposed to fetal-neonatal myocardium. Such characteristicswould include the presence of particular ion currents, the nature ofmuscle contraction, and the ability of the cardiomyocytes to divide(e.g. terminally differentiated) among others. For example, adultmyocardium generates more tension than fetal-neonatal myocardium andpossesses different calcium dynamics. Other morphological, mechanical,and electrical differences between adult myocardium and fetal-neonatalmyocardium are known to those skilled in the art. See, for example, Baumand Palmisano (1997) Anesthesiology, Vol. 87: 1529-1548, which is hereinincorporated by reference in its entirety. In preferred embodiments, thecardiac stem cells are autologous, that is, the cardiac stem cells areobtained from the same patient receiving the pharmaceutical composition.In another embodiment, the subject requiring repair of damagedmyocardium is suffering from a myocardial infarction.

In another embodiment of the invention, the method comprises extractingcardiac stem cells from the subject; incorporating a transgene into saidextracted cardiac stem cells, wherein said transgene encodes a microRNA;and administering the cardiac stem cells comprising the transgene to anarea of damaged myocardium in the subject, wherein the cardiac stemcells differentiate into mature, functional cardiomyocytes followingadministration, thereby regenerating the damaged myocardium. In apreferred embodiment, the transgene encodes miR-499. In anotherembodiment, the microRNA is overexpressed in the extracted cardiac stemcells. In yet another embodiment, extracting cardiac stem cells from thesubject comprises harvesting myocardial tissue from the subject andisolating the cardiac stem cells from said myocardial tissue. In aparticularly preferred embodiment, the subject is human.

In still another embodiment of the invention, the method furthercomprises administering vascular progenitor cells to an area of damagedmyocardium in the subject, wherein the vascular progenitor cells areautologous. In another embodiment, the vascular progenitor cellsdifferentiate into endothelial cells and smooth muscle cells, therebygenerating new vascular structures. The vascular structures formed bythe differentiation of the VPCs would complement the regeneration ofmyocardial tissue induced by the differentiation of the modified CSCs byproviding the necessary vasculature to supply oxygen to the newlygenerated myocardial tissue. The VPCs may be administered simultaneouslywith the modified CSCs or at some particular time after administrationof the modified CSCs.

The present invention also provides a method for regenerating damagedmyocardium in a subject in need thereof by administering unmodified CSCsand a transgene encoding a microRNA. In preferred embodiments, theunmodified CSCs are autologous or isolated from the subject to whichthey will be administered. Unmodified CSCs can differentiate intomyocytes, smooth muscle cells, and endothelial cells, which can assembleinto new myocardium and vascular structures. As discussed above, themajority of newly formed myocytes produced by unmodified CSCs fail toattain the mature cardiomyocyte phenotype. Subsequent administration ofa transgene encoding a microRNA to the newly formed myocytes promotesfurther differentiation and maturation such that the newly formedmyocytes exhibit the adult phenotype. Thus, in one embodiment of theinvention, the method comprises administering cardiac stem cells to anarea of damaged myocardium in a subject in need thereof, wherein thecardiac stem cells differentiate into myocytes, smooth muscle cells, andendothelial cells after their administration, thereby regenerating thedamaged myocardium; and administering a transgene encoding a microRNA tothe area of regenerated myocardium, wherein the regenerated myocardiumexhibits the functional characteristics of adult myocardium followingtransgene administration. In a preferred embodiment of the invention,the microRNA is miR-499.

The transgene encoding the microRNA can be administered to the newlyregenerated myocardium by various methods known to those skilled in theart for delivering nucleic acids, including, but not limited to,macromolecule complexes, nanocapsules, microspheres, beads, andlipid-based systems including oil-in-water emulsions, micelles, mixedmicelles, and liposomes. The transgene may be provided as apolynucleotide comprising the microRNA sequence or may be expressed froma vector, such as a viral vector as described above. In preferredembodiments, the transgene encoding the microRNA is expressed from alentiviral vector.

Thus, the invention involves administering a therapeutically effectivedose or amount of stem cells to the heart. An effective dose is anamount sufficient to effect a beneficial or desired clinical result.Said dose could be administered in one or more administrations. Asillustrated in the examples in co-pending U.S. Application PublicationNo. 2006/0239983, filed Feb. 16, 2006, which is herein incorporated byreference, 2×10⁴-1×10⁵ stem cells were sufficient to effect myocardialrepair and regeneration in a mouse model of myocardial infarction. Whilethere would be an obvious size difference between the hearts of a mouseand a human, it is possible that this range of stem cells would besufficient in a human as well. However, the precise determination ofwhat would be considered an effective dose may be based on factorsindividual to each patient, including their size, age, area ofmyocardial damage, and amount of time since damage. One skilled in theart, specifically a physician or cardiologist, would be able todetermine the number of stem cells that would constitute an effectivedose without undue experimentation.

In some embodiments of the invention, the modified cardiac stem cellsare activated prior to administration to a patient. Activation of thestem cells may be accomplished by exposing the stem cells to one or morecytokines, such as hepatocyte growth factor (HGF) or insulin-like growthfactor-1 (IGF-1). HGF positively influences stem cell migration andhoming through the activation of the c-Met receptor (Kollet et al.(2003) J. Clin. Invest. 112: 160-169; Linke et al. (2005) Proc. Natl.Acad. Sci. USA 102: 8966-8971; Rosu-Myles et al. (2005) J. Cell. Sci.118: 4343-4352; Urbanek et al. (2005) Circ. Res. 97: 663-673).Similarly, IGF-1 and its corresponding receptor (IGF-1R) induce cardiacstem cell division, upregulate telomerase activity, hinder replicativesenescence and preserve the pool of functionally-competent cardiac stemcells in the heart (Kajstura et al. (2001) Diabetes 50: 1414-1424;Torella et al. (2004) Circ. Res. 94: 514-524; Davis et al. (2006) Proc.Natl. Acad. Sci. USA 103: 8155-8160). In a preferred embodiment, themodified cardiac stem cells are contacted with HGF and/or IGF-1. In oneembodiment, HGF is present in an amount of about 0.1-400 ng/ml. Inanother embodiment, HGF is present in an amount of about 25, about 50,about 75, about 100, about 125, about 150, about 175, about 200, about225, about 250, about 275, about 300, about 325, about 350, about 375 orabout 400 ng/ml. In another embodiment, IGF-1 is present in an amount ofabout 0.1-500 ng/ml. In yet a further embodiment, IGF-1 is present in anamount of about 25, about 50, about 75, about 100, about 125, about 150,about 175, about 200, about 225, about 250, about 275, about 300, about325, about 350, about 375, about 400, about 425, about 450, about 475,or about 500 ng/ml.

Some other non-limiting examples of cytokines that are suitable for theactivation of the modified cardiac stem cells include Activin A, BoneMorphogenic Protein 2, Bone Morphogenic Protein 4, Bone MorphogenicProtein 6, Cardiotrophin-1, Fibroblast Growth Factor 1, FibroblastGrowth Factor 4, Flt3 Ligand, Glial-Derived Neurotrophic Factor,Heparin, Insulin-like Growth Factor-II, Insulin-Like Growth FactorBinding Protein-3, Insulin-Like Growth Factor Binding Protein-5,Interleukin-3, Interleukin-6, Interleukin-8, Leukemia Inhibitory Factor,Midkine, Platelet-Derived Growth Factor AA, Platelet-Derived GrowthFactor BB, Progesterone, Putrescine, Stem Cell Factor, Stromal-DerivedFactor-1, Thrombopoietin, Transforming Growth Factor-α, TransformingGrowth Factor-β1, Transforming Growth Factor-β2, Transforming GrowthFactor-β3, Vascular Endothelial Growth Factor, Wnt1, Wnt3a, and Wnt5a,as described in Kanemura et al. (2005) Cell Transplant. 14:673-682;Kaplan et al. (2005) Nature 438:750-751; Xu et al. (2005) Methods Mol.Med. 121:189-202; Quinn et al. (2005) Methods Mol. Med. 121:125-148;Almeida et al. (2005) J Biol Chem. 280:41342-41351; Barnabe-Heider etal. (2005) Neuron 48:253-265; Madlambayan et al. (2005) Exp Hematol33:1229-1239; Kamanga-Sollo et al. (2005) Exp Cell Res 311:167-176;Heese et al. (2005) Neuro-oncol. 7:476-484; He et al. (2005) Am JPhysiol. 289:H968-H972; Beattie et al. (2005) Stem Cells 23:489-495;Sekiya et al. (2005) Cell Tissue Res 320:269-276; Weidt (2004) StemCells 22:890-896; Encabo et al (2004) Stem Cells 22:725-740; andBuytaeri-Hoefen et al. (2004) Stem Cells 22:669-674, the entire text ofeach of which is incorporated herein by reference.

Functional variants of the above-mentioned cytokines can also beemployed in the invention. Functional cytokine variants would retain theability to bind and activate their corresponding receptors. Variants caninclude amino acid substitutions, insertions, deletions, alternativesplice variants, or fragments of the native protein. For example, NK1and NK2 are natural splice variants of HGF, which are able to bind tothe c-MET receptor. These types of naturally occurring splice variantsas well engineered variants of the cytokine proteins that retainfunction are contemplated by the invention.

The modified cardiac stem cells as well as other adult stem cells, suchas VPCs, may be administered to the heart by injection. The injection ispreferably intramyocardial. As one skilled in the art would be aware,this is the preferred method of delivery for stem cells as the heart isa functioning muscle. Injection by this route ensures that the injectedmaterial will not be lost due to the contracting movements of the heart.In one embodiment, the stem cells are administered to the border zone ofthe damaged myocardium. Damaged myocardium, which typically containsinfarcted tissue, is visible grossly allowing for this specificplacement of the stem cells.

In a further aspect of the invention, the stem cells are administered byinjection transendocardially or trans-epicardially. In a preferredembodiment, a catheter-based approach to deliver the trans-endocardialinjection of stem cells is employed. The use of a catheter precludesmore invasive methods of delivery wherein the opening of the chestcavity would be necessitated. As one skilled in the art wouldappreciate, optimum time of recovery would be allowed by the moreminimally invasive procedure. A catheter approach involves the use ofsuch techniques as the NOGA catheter or similar systems. The NOGAcatheter system facilitates guided administration by providingelectromechanic mapping of the area of interest, as well as aretractable needle that can be used to deliver targeted injections or tobathe a targeted area with a therapeutic. Any of the embodiments of thepresent invention can be administered through the use of such a systemto deliver injections or provide a therapeutic. One of skill in the artwill recognize alternate systems that also provide the ability toprovide targeted treatment through the integration of imaging and acatheter delivery system that can be used with the present invention.Information regarding the use of NOGA and similar systems can be foundin, for example, Sherman (2003) Basic Appl. Myol. 13: 11-14; Patel etal. (2005) The Journal of Thoracic and Cardiovascular Surgery130:1631-38; and Perrin et al. (2003) Circulation 107: 2294-2302; thetext of each of which are incorporated herein in their entirety. One ofskill in the art will recognize other useful methods of delivery orimplantation which can be utilized with the present invention, includingthose described in Dawn et al. (2005) Proc. Natl. Acad. Sci. USA 102,3766-3771, the contents of which are incorporated herein in theirentirety.

The compositions and methods of the present invention are useful for thetreatment of cardiovascular disease, including, but not limited to,atherosclerosis, ischemia, myocardial infarction, hypertension,restenosis, angina pectoris, rheumatic heart disease, congenitalcardiovascular defects, age-related cardiomyopathy, and arterialinflammation and other disease of the arteries, arterioles andcapillaries. Specifically, the methods of the present invention providefor the repair and/or regeneration of damaged myocardium resulting fromone of the diseases listed above or from the general decline ofmyocardial cells with age.

The present invention contemplates pharmaceutical compositionscomprising an effective amount of modified stem cells described hereinand a pharmaceutically acceptable carrier. In preferred embodiments, thepharmaceutical compositions comprise cardiac stem cells, said cardiacstem cells comprising a transgene. When administering a composition ofthe present invention, it will generally be formulated in a unit dosageinjectable form (solution, suspension, emulsion). The pharmaceuticalformulations suitable for injection include sterile aqueous solutions ordispersions and sterile powders for reconstitution into sterileinjectable solutions or dispersions. The carrier can be a solvent ordispersing medium containing, for example, water, ethanol, polyol (forexample, glycerol, propylene glycol, liquid polyethylene glycol, and thelike), suitable mixtures thereof, and vegetable oils. Examples ofcompositions comprising modified stem cells of the invention includeliquid preparations for parenteral, subcutaneous, intradermal,intramuscular or intravenous administration (e.g., injectableadministration), such as sterile suspensions or emulsions. Suchcompositions may be in admixture with a suitable carrier, diluent, orexcipient such as sterile water, physiological saline, glucose or thelike. The compositions can also be lyophilized. The compositions cancontain auxiliary substances such as wetting or emulsifying agents, pHbuffering agents, gelling or viscosity enhancing additives,preservatives, flavoring agents, colors, and the like, depending uponthe route of administration and the preparation desired. Standard texts,such as “REMINGTON'S PHARMACEUTICAL SCIENCE”, 17th edition, 1985,incorporated herein by reference, may be consulted to prepare suitablepreparations, without undue experimentation.

Pharmaceutical compositions of the invention, are conveniently providedas liquid preparations, e.g., isotonic aqueous solutions, suspensions,emulsions or viscous compositions which may be buffered to a selectedpH. Solutions, suspensions and gels normally contain a major amount ofwater (preferably purified water) in addition to the active compound.Minor amounts of other ingredients such as pH adjusters (e.g., a basesuch as NaOH), emulsifiers or dispersing agents, buffering agents,preservatives, wetting agents, jelling agents, (e.g., methylcellulose),colors and/or flavors may also be present. The compositions can beisotonic, i.e., they can have the same osmotic pressure as blood andlacrimal fluid.

The desired isotonicity of the compositions of this invention may beaccomplished using sodium chloride, or other pharmaceutically acceptableagents such as dextrose, boric acid, sodium tartrate, propylene glycolor other inorganic or organic solutes. Sodium chloride is preferredparticularly for buffers containing sodium ions.

Viscosity of the compositions may be maintained at the selected levelusing a pharmaceutically acceptable thickening agent. Methylcellulose ispreferred because it is readily and economically available and is easyto work with. Other suitable thickening agents include, for example,xanthan gum, carboxymethyl cellulose, hydroxypropyl cellulose, carbomer,and the like. The preferred concentration of the thickener will dependupon the agent selected. The important point is to use an amount whichwill achieve the selected viscosity. Viscous compositions are normallyprepared from solutions by the addition of such thickening agents.

Additionally, various additives which enhance the stability, sterility,and isotonicity of the compositions, including antimicrobialpreservatives, antioxidants, chelating agents, and buffers, can beadded. Prevention of the action of microorganisms can be ensured byvarious antibacterial and antifungal agents, for example, parabens,chlorobutanol, phenol, sorbic acid, and the like. In many cases, it willbe desirable to include isotonic agents, for example, sugars, sodiumchloride, and the like. Prolonged absorption of the injectablepharmaceutical form can be brought about by the use of agents delayingabsorption, for example, aluminum monostearate and gelatin. According tothe present invention, however, any vehicle, diluent, or additive usedwould have to be compatible with the compounds.

A pharmaceutically acceptable preservative can be employed to increasethe shelf-life of the compositions. Benzyl alcohol may be suitable,although a variety of preservatives including, for example, parabens,thimerosal, chlorobutanol, or benzalkonium chloride may also beemployed. A suitable concentration of the preservative will be from0.02% to 2% based on the total weight although there may be appreciablevariation depending upon the agent selected.

Those skilled in the art will recognize that the components of thecompositions should be selected to be chemically inert with respect tothe active compound. This will present no problem to those skilled inchemical and pharmaceutical principles, or problems can be readilyavoided by reference to standard texts or by simple experiments (notinvolving undue experimentation), from this disclosure and the documentscited herein.

Sterile injectable solutions can be prepared by incorporating thecompounds utilized in practicing the present invention in the requiredamount of the appropriate solvent with various amounts of the otheringredients, as desired.

The quantity of the pharmaceutical composition to be administered willvary for the patient being treated. In a preferred embodiment,2×10⁴-1×10⁵ modified cardiac stem cells are administered to the patient.However, the precise determination of what would be considered aneffective dose may be based on factors individual to each patient,including their size, age, area of damaged myocardium, and amount oftime since damage. Thus, the skilled artisan can readily determine thedosages and the amount of compound and optional additives, vehicles,and/or carrier in compositions to be administered in methods of theinvention. Typically, any additives (in addition to the active modifiedstem cells) are present in an amount of 0.001 to 50 wt % solution inphosphate buffered saline, and the active ingredient is present in theorder of micrograms to milligrams, such as about 0.0001 to about 5 wt %,preferably about 0.0001 to about 1 wt %, most preferably about 0.0001 toabout 0.05 wt % or about 0.001 to about 20 wt %, preferably about 0.01to about 10 wt %, and most preferably about 0.05 to about 5 wt %. Ofcourse, for any composition to be administered to an animal or human,and for any particular method of administration, it is preferred todetermine therefore: toxicity, such as by determining the lethal dose(LD) and LD₅₀ in a suitable animal model e.g., rodent such as mouse;and, the dosage of the composition(s), concentration of componentstherein and timing of administering the composition(s), which elicit asuitable response. Such determinations do not require undueexperimentation from the knowledge of the skilled artisan, thisdisclosure and the documents cited herein. And, the time for sequentialadministrations can be ascertained without undue experimentation. Insome embodiments, the pharmaceutical composition further comprises VPCs.1×10⁴-1×10⁵ VPCs may be administered to the patient. However, theprecise dosage will depend on the type of cardiac disease to be treated,the amount of myocardial and coronary vasculature damage,characteristics of the individual patient, and the dosage of modifiedcardiac stem cells the patient has received or is going to receive.Adjustments of VPC dosage can be readily ascertained by the skilledartisan.

The inventive compositions of this invention are prepared by mixing theingredients following generally accepted procedures. The mixture maythen be adjusted to the final concentration and viscosity by theaddition of water or thickening agent and possibly a buffer to controlpH or an additional solute to control tonicity. Generally the pH may befrom about 3 to 7.5. Compositions can be administered in dosages and bytechniques well known to those skilled in the medical and veterinaryarts taking into consideration such factors as the age, sex, weight, andcondition of the particular patient, and the composition form used foradministration (e.g., solid vs. liquid). Dosages for humans or othermammals can be determined without undue experimentation by the skilledartisan, from this disclosure, the documents cited herein, and theknowledge in the art.

Suitable regimes for initial administration and further doses or forsequential administrations also are variable, may include an initialadministration followed by subsequent administrations; but nonetheless,may be ascertained by the skilled artisan, from this disclosure, thedocuments cited herein, and the knowledge in the art.

The pharmaceutical compositions of the present invention are used totreat heart failure and cardiovascular diseases, including, but notlimited to, atherosclerosis, ischemia, hypertension, myocardialinfarction, restenosis, angina pectoris, rheumatic heart disease,congenital cardiovascular defects and arterial inflammation and otherdiseases of the arteries, arterioles and capillaries or relatedcomplaint. Accordingly, the invention involves the administration ofmodified adult stem cells as herein discussed for the treatment orprevention of any one or more of these conditions or other conditionsinvolving weakness in the heart. And, advantageous routes ofadministration involves those best suited for treating these conditions,such as via injection, including, but are not limited to intravenous,intraarterial, intramuscular, intramyocardial, transendocardial, andtrans-epicardial.

This invention is further illustrated by the following additionalexamples that should not be construed as limiting. The contents of allreferences, patents and published patent applications cited throughoutthis application, as well as the Figures, are incorporated herein byreference in their entirety.

Examples Example 1 Specific microRNAs are Differentially Expressed inAdult Cardiomyocytes and Cardiac Stem Cells

Studies in embryonic stem cells, neural stem cells and hematopoieticstem cells have shown that the regulation of self-renewal,multipotentiality and commitment occurs only in part at thetranscriptional level (Ramalho-Santos et al., 2002; Ivanova et al.,2002; Bruno et al., 2004; and Bhattacharya et al., 2004). Althoughtranscription factors are critical modulators of stem cell growth anddifferentiation, post-transcriptional gene regulation is emerging as anunexpected mechanism of progenitor cell fate. MicroRNAs (miRs) are smallRNAs that regulate the post-transcriptional expression of proteinsgenerated from mRNA transcripts (Alvarez-Garcia and Miska, 2005; Chapmanand Carrington, 2007; and Chu and Rana, 2007). They are transcribed byRNA polymerase II and subsequently processed by the RNase III enzymes,Drosha and Dicer, into mature miRs of ˜20-22 nucleotides (Tijsterman andPlasterk, 2004; and Gregory et al, 2006). These RNA strands bind toproteins of the Argonaute family forming RNA-induced silencing complexesthat mediate distinct gene silencing mechanisms (Peters and Meister,2007). MiRs inhibit gene expression by modulating the stability and/orthe translation of the target mRNA (Alvarez-Garcia and Miska, 2005;Chapman and Carrington, 2007; and Chu and Rana, 2007). The degree ofsequence complementarity with the target determines whether the miRinhibits protein translation by binding to the 3′ untranslated region(3′-UTR) (less complementary) or degrades the mRNA (100% complementary).Additionally, miRs promote gene silencing through chromatin remodeling.Enzymes that modify histones and DNA methyltransferases are miR-targets(Tuddenham et al., 2006; Saetrom et al., 2007; and Chuang and Jones,2007). In turn, DNA methylation and histone post-translationalmodifications regulate the quantity of several miRs (Saetrom et al.,2007; Chuang and Jones, 2007; and Yu et al., 2005).

Different sets of miRs are expected to be present in multipotent cardiacstem cells (CSCs) and their progeny. Importantly, miRs may repress stemcell maintenance genes promoting the differentiation of CSCs intocardiomyocytes. The transition from the primitive to the committed stateof CSCs requires a rapid switch in gene expression. Although the pool oftranscription factors may be replaced, the residual transcripts of thestemness-related genes that were highly expressed in the previousundifferentiated stage have to be silenced; and miRs can simultaneouslyrepress multiple targets (Alvarez-Garcia and Miska, 2005; Chapman andCarrington, 2007; and Chu and Rana, 2007). Thus, it is possible thatmiRs that are highly expressed in cardiomyocytes and minimally presentor absent in undifferentiated CPCs may be involved in the maintenance ofthe terminally differentiated state of myocytes and may translocate toneighboring CPCs initiating their differentiation.

In this Example, a group of miRs that are particularly abundant inmyocytes were identified by employing a miR array approach. As shown inFIG. 1, several miRs, including miR-1, miR-499, miR-133, miR-30, miR-26and let-7, were found to be expressed in rat cardiomyocytes. However,only the expression of miR-1, miR-499 and miR-133 differed significantlyin myocytes and CSCs. Both miR-1 and miR-133 have been shown to beinvolved in the modulation of cardiac growth. The function of miR-1appears to be mostly related to cardiac development since itsoverexpression inhibits myocyte proliferation and the expansion of theventricular myocardium in the embryonic heart (Zhao et al., 2005).Additionally, targeted deletion of miR-1-2 carries a 50% lethalitypredominantly mediated by ventricular-septal defects (Zhao et al.,2007). Importantly, in the adult heart, miR-1 is downregulated duringthe development of the myocyte hypertrophic response following aorticbanding (Sayed et al., 2007) and direct injection of miR-1 in theinfarcted myocardium results in severe rhythm disturbances (Yang et al.,2007). Similarly, miR-133 is downregulated during myocardial hypertrophyin animals and humans (Carè et al., 2007). This inhibitory function ofmiR-133 in myocyte hypertrophy has been confirmed in vitro with neonataland adult mouse myocytes (Sayed et al., 2007). Thus, since both miR-1and miR-133 prevent myocyte hypertrophy (Sayed et al., 2007; Tatsuguchiet al., 2007; van Rooij and Olson, 2007), it is unlikely that theirfunction is linked to CSC differentiation and formation of adultmyocytes.

MiR-499 is highly expressed in the rat heart and its quantity is˜500-fold higher in myocytes than in CSCs (FIGS. 1 and 2A). MiR-499 hasbeen discovered recently (Berezikov et al., 2005; and Bentwich et al.,2005). Nearly one-third of miRs is encoded within the introns of primarygenes and is processed out of the primary gene pre-mRNA rather thanbeing transcribed as separate transcripts (Baskerville and Bartel,2005). Therefore, the expression of these miRs is under the control ofthe promoter driving the transcription of the primary mRNA (Baskervilleand Bartel, 2005). MiR-499 is encoded within the intron of the newlyidentified Myh7b gene, which encodes a member of the sarcomeric myosinheavy chain (MHC) protein family (Nagase et al., 2000; and Desjardins etal., 2002). The Myh7b gene is expressed in the brain, heart, skeletalmuscle and testis (Nagase et al., 2000) and has a 70% degree of homologywith β-MHC both at the mRNA and protein levels (FIG. 2B). This degree ofhomology is lower than the similarity between α- and β-MHC indicatingthat Myh7b is a distinct gene. Additionally, the putative promoterregion of Myh7b contains Nkx2.5 binding consensus sequences (FIG. 2B).Importantly, miR-499 and Myh7b are encoded in the same orientation inall species including humans indicating that the RNAs of these twosequences are simultaneously transcribed.

Example 2 MiR-499 Targets Rod1 and Sox D Proteins

By employing the web-based target-prediction program TargetScan version4, ˜200 putative target genes of miR-499 were identified. Among thegenes that scored as strong predicted-targets, based on highcomplementarity and evolutionary conservation, 3 genes were selected forfurther study for their potential role in CSC division anddifferentiation: SRY (sex determining region Y)-box 5 (Sox5) and 6(Sox6) and Regulator of Differentiation 1 (Rod1). The 3′-UTR of Sox5,Sox6 and Rod1 gene contains 1, 3 and 2 evolutionary conserved miR-499binding sites, respectively. These putative miR-499 binding sites in the3′-UTR of Sox5, Sox6 and Rod1 mRNA showed high complementarity with theseed region of miR-499 (FIG. 3).

SRY-related high-mobility-group box (Sox) transcription factors areimplicated in cell fate determination in multiple organs (Lefebvre etal., 2007). They are encoded by twenty genes in humans and mice andshare a highly conserved high-mobility-group box domain that wasoriginally identified in SRY, the sex-determining gene on the Ychromosome (Sinclair et al., 1990; and Gubbay et al., 1990). Based onthe similarity in protein sequence, Sox transcription factors have beendivided in 8 groups, A to H (Lefebvre et al., 2007). Although thefunction of Sox genes remains largely unknown, SoxB1 genes appear tocontrol the preservation of sternness in primitive cells (Graham et al.,2003; Bylund et al., 2003; Pevny and Placzek, 2005; and Wegner andStolt, 2005), while Sry (SoxA), SoxC, SoxE and SoxF genes promote thespecification of lineage fate in stem cells and their early stages ofdifferentiation (Pennisi et al., 2000; Maka et al., 2005; Wilson et al.,2005; Dewing et al., 2006; Matsui et al., 2006; O'Donnell et al., 2006;and Bergsland et al., 2006). SoxD genes, which include Sox5 and Sox6,modulate terminal maturation of committed progenitor cells actingdownstream with respect to the developmental decision of cell fate(Smits et al., 2001; Yi et al., 2006; Dumitriu et al., 2006; and Stoltet al., 2006). Deletion of the Sox6 gene in mice is associated withalterations in cardiac conduction (Hagiwara et al., 2000). In vitro datacollected in the embryonic carcinoma cell line P19CL6 suggest that theexpression of Sox6 is coupled with commitment to the myocyte lineagebut, surprisingly, with a downregulation of the α1c subunit of theL-type Ca2+ channels (Cohen-Barak et al., 2003). Rod1 is the mammalianhomologue of nrd1 which is an RNA binding protein that acts as negativeregulator of differentiation in fission yeasts (Tsukahara et al., 1998).Rod1 was isolated in 1999 and found to be able to block differentiationof erythrocytes and megakaryocytes (Yamamoto et al., 1999).

Reporter assays were performed to validate the putative miR-499-targetgene combination. This strategy allowed the determination of whethermiR-499 binds to the transcripts of Sox6 and Rod1 genes and interfereswith their translation. The 3′-UTR sequences of the two genes wereobtained by PCR, sequenced and ligated at a position downstream of theluciferase coding sequence in reporter plasmids (see method sectionbelow). In this system, the potential interaction between miR-499 andthe 3′-UTR of Sox6 and Rod1 should result in downregulation ofluciferase expression. A β-gal-expressing plasmid was employed tonormalize luciferase activity. The reporter construct was under thecontrol of the cytomegalovirus (CMV) promoter. Mouse NIH-3T3 fibroblastswere transfected with pre-miR-499. This cell line was selected tominimize the influence of endogenous expression of miR-499. One daylater, cells were co-transfected with luciferase reporter plasmids (Sox6or Rod1) and β-gal expression vectors. Then, cells were harvested 24hours later. A pre-miR random sequence was used as negative control, andbasal expression level of luciferase was measured in the absence ofmiR-499. The decrease in luciferase activity documented that thepresence of miR-499 markedly interfered with the translation of the twoconstructs indicating that Sox6 and Rod1 are target genes of miR-499(FIG. 4A).

Additional reporter assays were performed utilizing a plasmid carryingmiR-499. A murine genomic DNA fragment of 254 bp including miR-499 wascloned into a plasmid downstream of the CMV promoter. The plasmid(CMV-miR-499) was transfected into NIH-3T3 fibroblasts. Nearly 105 cellswere seeded and transfected with 1 μg of CMV-miR-499. Cells wereharvested 3 days later for RNA isolation. Cells transfected with blankplasmids (CMV-blank) were used as negative control. About 1 ng of totalRNA from each condition was used to quantify the mature form of miR-499;small nucleolar RNA sno-412 was employed as endogenous control RNA fornormalization of miR-499 expression. As expected, 3T3 cells transfectedwith CMV-blank showed minimal expression level of miR-499 whereas cellscontaining CMV-miR-499 had ˜5,500-fold higher level of expression (FIG.4B, C). To document that the transcribed miR-499 in the cells wasfunctional, luciferase assay was performed as discussed above. 3T3 cellswere co-transfected with CMV-miR-499 and reporter plasmids containingthe luciferase coding sequence alone or conjugated with the 3′-UTR ofSox6 and Rod1. CMV-blank was used as negative control and to adjust thetotal amount of DNA to be transfected. Importantly, cells transfectedwith luciferase reporter lacking 3′-UTR showed intact levels ofluciferase activity. Conversely, a striking decrease in luciferaseactivity was measured in cells that received reporter plasmids with3′-UTR of Sox6 and Rod1. The downregulation of luciferase activityoccurred in a dose-dependent manner when increasing concentrations ofCMV-miR-499 plasmids were used (FIG. 4D).

The data in FIG. 4 indicate that Sox6 and Rod1 represent actual targetgenes of miR-499, demonstrating a functional role for miR-499, which mayhave important implications in cardiac homeostasis and regeneration.CSCs have recently been identified and characterized in the human heartand have been found to regenerate large quantities of immature myocytes(Bearzi et al., 2007). MiR-499 may be able to favor the differentiationof newly formed human myocytes and promote their acquisition of theadult phenotype.

Importantly, the self-renewal, clonogenicity and multipotentiality ofhuman cardiac stem cells (hCSCs) were documented in vivo by genetictagging (Hosoda et al., 2008). Integration site analysis with aPCR-based method that can distinguish the progeny of each transducedstem cell by its unique proviral-genomic fusion sequence was performed.hCSCs were infected with EGFP-lentivirus and employed to induce cardiacrepair after infarction. hCSCs, myocytes, endothelial cells andfibroblasts were collected from the regenerated myocardium and theinsertion-site of the EGFP-gene in the human genome was detected bynested PCR. This novel approach revealed that hCSCs acquire a cardiacphenotype in vivo and myocardial regeneration has a polyclonal origin(Hosoda et al., 2008). Thus, the commitment of hCSCs to myocytes andtheir terminal maturation may be associated with (a) translocation ofmiR-499 from cardiomyocytes to neighboring hCSCs through gap junctions;(b) accumulation of miR-499 in hCSCs; (c) stable or decreased levels ofthe transcripts of the target genes of miR-499, Sox5, Sox6 and Rod1; (d)decrease in Sox5, Sox6 and Rod1 proteins; (e) upregulation ofmyocyte-specific transcription factors and contractile proteins; and (f)acquisition of electrical, mechanical and Ca2+ transient properties offunctionally-competent adult myocytes.

The following experiments were performed to test whether miR-499 is acrucial modulator of the differentiation of CSCs into cardiomyocytes andwhether this function of miR-499 is mediated by the repression of Sox6and Rod1. First, the transcript levels of Sox6 and Rod1 were measured inrat myocytes, human myocardium, rat CSCs and hCSCs by quantitativeRT-PCR. Sox6 mRNA was 2-fold higher and Rod1 mRNA was 98% lower in ratmyocytes than in rat CSCs (FIG. 5A). The transcripts of the three genes,Sox5, Sox6 and Rod1 were highly expressed in the human myocardium (FIG.5D). By Western blotting, the protein levels of Sox6 and Rod1 weresignificantly decreased in rat myocytes with respect to CSCs suggestingthat miR-499 promotes degradation and/or inhibition of translation ofthese target genes (FIG. 5B). Importantly, the decrease in expression ofSox6 and Rod1 protein in rat myocytes (FIG. 5B,C) is consistent with thehigher quantity of miR-499 in these cells. These findings support therole of miR-499 and its target genes Sox6 and Rod1 in thedifferentiation of CSCs into cardiomyocytes.

Specific Methods

Human CSCs. Discarded myocardial samples (n=10) were obtained frompatients who underwent open heart surgery. hCSCs were harvested byenzymatic dissociation as previously described (Bearzi et al., 2007).Briefly, cardiac tissue samples were incubated in a solution containingcollagenase to obtain a single cell suspension. Cells were labeled witha c-kit antibody conjugated with magnetic beads (Miltenyi). hCSCs werethen expanded, infected with a lentivirus carrying EGFP and employed forfurther studies. Expanded hCSCs were stained with a c-kit antibody andsorted by FACS prior to their use to collect a highly homogenouspopulation of undifferentiated cells with a 95-98% degree of enrichmentfor the stem cell antigen c-kit. This step also allows the assessment ofthe efficiency of EGFP infection.

Construction of plasmids. Expression plasmids encoding miR-499, Sox5,Sox6, and Rod1 as well as luciferase reporter plasmids were prepared asfollows.

a) miR-499 expression plasmid. The pMIR-REPORT β-gal Control Plasmid wasmodified by digesting with BamH1 and Hind3, blunted with T4 DNApolymerase, and then self-ligated with T4 DNA ligase to serve as blankplasmid (CMV-blank). Mouse genomic DNA coding the stem loop of miR-499together with the two flanking regions of ˜100 bp each was amplifiedwith the primers indicated below. The construct was ligated to replacethe β-gal gene in the Control Plasmid and obtain the miR-499 expressionplasmid (CMV-miR-499).

miR-499-BamH1-F: 5′-CCT AAG GAT CCC ACG CCC CCT ACA GGC TGC CAC-3′miR-499-Hind3-R: 5′-ACC TAA AGC TTC ACC GCC CCC CCA CCC CCA G-3′To confirm the function of the plasmids, 105 3T3 fibroblasts weretransfected with 1 μg of CMV-blank or CMV-miR-499; 3 days later, RNA wasextracted and miR-499 was measured by quantitative RT-PCR (see below).

b) Luciferase reporter plasmids. The pMIR-REPORT Luciferase andpMIR-REPORT β-gal Control Plasmid were obtained from Applied Biosystemsand utilized for transfection with or without modifications. Mousegenomic DNA was amplified to obtain the 3′ untranslated region (3′-UTR)of Sox6 (5.6 kb) and Rod1 (5.0 kb) genes using the primers indicatedbelow. However, the sequence was partly modified (see underlinednucleotides) to introduce restriction sites in the amplicons.

mSox6-MluI-F2: 5′-TGT TTG ACG CGT TAA AAC ACT CTG ACA TTT CGC TCC-3′mSox6-PmeI-R: 5′-AGT CCT GTT TAA ACT TCT CTT TAT CAC TAT CCA GAG-3′mRod1-MluI-F: 5′-TGA CCT ACG CGT GAA ATT GTC TCC TTA TAC TGG AC-3′mRod1-PmeI-R: 5′-AAA AGG GTT TAA ACA ATG CTA TAT GTG TTA GGA AAA GAGGC-3′

The reaction mixture consisted of 22.5 μl of AccuPrime Pfx SuperMix(Invitrogen), 5 pmole each of Forward and Reverse primers and 50 ng ofgenomic DNA extracted from adult mouse heart using QIAamp DNA Mini Kit(Qiagen). PCR cycling conditions were as follows: 95° C. for 5 minfollowed by 35 cycles of amplification (95° C. for 15 sec, 60° C. for 30sec and 68° C. for 5 min 30 sec) and the last step at 68° C. for 5 min.PCR products were run on 0.6% agarose/1× TBE gel. The DNA bands were cutout and DNA was extracted using QIAEX II Gel Extraction Kit (Qiagen).Following restriction digestion with MluI and PmeI for Sox6 3′-UTR andRod1 3′-UTR, DNA sequences were directionally ligated to pMIR-REPORTLuciferase plasmid (Applied Biosystems). This plasmid has a multiplecloning site downstream of the luciferase gene which is placed under thecontrol of the CMV promoter. To exclude the possibility of erroneousamplification events, constructs were fully sequenced utilizing thepMIR-REPORT-1 primer (5′-AGG CGA TTA AGT TGG GTA-3′) which is locateddownstream of the multiple cloning site. Additional primers weredesigned at a distance of 500 bp with each other within the ampliconsand employed to verify construct sequences.

A similar approach is employed to obtain a reporter plasmid in whichluciferase is placed upstream from the 3′-UTR of Sox5. To obtain the3′-UTR of Sox5, the following primers are used:

mSox5-Nae1-F: 5′-ATA AGG GCC GGC AGA CTG TGG TGA GCC GAG GAC TT-3′mSox5-PmeI-R: 5′-TTT CTT TTT AAA AAT TGT AGC ACA GAA CAA C-3′Restriction digestion is carried out with NaeI and PmeI.

c) siRNA transfection. siRNA for human Sox5, Sox6 and Rod1 is obtainedfrom Dharmacon and corresponds to a mixture of 4 different duplexes foreach gene. siRNA has a highly complimentary sequence to induce thedegradation of the target mRNA. For transfection, a final concentrationof 100 nM siRNAs against Sox5, Sox6, Rod1 or random control siRNA isused together with TransPass R2 Transfection Reagent (New EnglandBiolabs) to induce interference in hCSCs. Non-transfected cells will beused as control.

d) Expression plasmids for Sox5, Sox6 and Rod1. PCR is performed suchthat Hind3 and EcoR1 restriction sites are introduced in the amplicon atthe 5′- and 3′-side, respectively. The amplicons containing the fullcoding sequence of each human gene is ligated into the multiple cloningsite of pcDNA3 expression plasmid following restriction digestion withHind3 and EcoR1.

hSox5-Hind3-F: 5′-TTT AGA AGC TTT GGA CTC ACT TGA CAG G-3′hSox5-EcoR1-R: 5′-GTT AGG AAT TCT TTA AGT CCT AAG GTC AC-3′hSox6-Hind3-F: 5′-ATG GTA AGC TTC AAG GAC ATG AAA GGT T-3′hSox6-EcoR1-R: 5′-TAC TTG AAT TCA GCA AAC AAA AAC TCC TC-3′hRod1-Hind3-F: 5′-AGC CAA AGC TTG CTT GTC CCC GGA ACC G-3′hRod1-EcoR1-R: 5′-GAG AAG AAT TCA CAG AAA AGT CAG ATT GTA G-3′

Quantitative RT-PCR for miR-499. RNA was extracted from hCSCs, ratneonatal myocytes, C2C12 myoblasts and 3T3 cells with mirVana miRNAisolation kit (Applied Biosystems). One ng of total RNA including thesmall RNA fraction was reverse transcribed utilizing a specific primerfor miR-499 and the TaqMan MicroRNA reverse transcription kit (AppliedBiosystems). The cDNA was subsequently amplified with forward andreverse primers together with FAM-labeled probe for the quantification.Equal amounts of RNA were used for the quantification of small nucleolarRNA RNU44 (human) and sno-412 (mouse) that was employed for thenormalization of the expression level of miR-499.

Example 3 MiR-499 Translocates from Neighboring Cells to Cardiac StemCells through Gap Junctions

Engraftment of hCSCs in proximity of the infarct is the initialfundamental process of tissue repair. Engraftment requires theexpression of surface proteins involved in cell-to-cell contact and theconnection between cells and the interstitium. This process ischaracterized by the formation of gap and adherens junctions betweenCSCs and neighboring cells. Intercellular communication is critical forthe survival of homed cells in the hostile milieu of the ischemicmyocardium; also it appears to have other important functions (Bearzi etal., 2007; Urbanek et al., 2006; and Rota et al., 2007). Similarcell-to-cell interactions are present in the intact myocardium wherethis intercellular system may condition the fate of progenitor cells byinfluencing their state of quiescence, proliferation or lineagecommitment. hCSCs are organized in clusters and form gap and adherensjunctions with myocytes and fibroblasts which operate as supportingcells within cardiac stem cell niches (Urbanek et al., 2006).

Intercellular communications allow individual cells of an organism toaccomplish their function in a coordinated manner in multicellularorgans and tissues (Vinken et al., 2006; Hervé et al., 2007; and Me

e et al., 2007). Specifically, gap junctional communications rely onintercellular protein channels, which span the lipid bi-layers ofcontiguous cells and permit the direct exchange of ions and smallmolecules (Söhl and Willecke, 2004; Peters, 2006; Loewenstein, 1981; andNeijssen et al., 2005). Molecules of approximately 1.0-1.5 kDa werethought to represent the upper limit for permeation through gap junctionchannels (Loewenstein, 1981; and Neijssen et al., 2005). The recentdocumentation that synthetic oligonucleotides with molecular weights of2-4 kDa can traverse gap junction channels made by connexin 43 hasraised the intriguing possibility of a novel modality of intercellularcontrol of gene expression (Valiunas et al., 2005; Wolvetang et al.,2007; and Todorova et al., 2008). Short RNAs translocate between mouse,rat and human cells in different in vitro systems (Valiunas et al.,2005), including human embryonic stem cells (Wolvetang et al., 2007; andTodorova et al., 2008).

The presence of gap junctions between cells of different type, i.e.cardiomyocytes and hCSCs, suggests that gap junctions provide a pathwayfor the passage of information from differentiated cells to progenitorcells. Deletion of connexin 43 in osteoblasts and stromal cells of thebone marrow results in severe defects in hematopoiesis indicating thatgap junctions play a crucial role in blood cell generation in embryonicand post-natal life (Cancelas et al., 2000; Montecino-Rodriguez andDorshkind, 2001; and Rosendaal and Jopling, 2003). Deficiency ofconnexin 43 induces a maturation arrest of long-term repopulatinghematopoietic stem cells (HSCs), which show an impaired ability toproliferate and differentiate (Cancelas et al., 2000;Montecino-Rodriguez and Dorshkind, 2001; and Rosendaal and Jopling,2003). Thus, in the bone marrow niches, a cross-talk occurs through gapjunctions between HSCs and supporting cells. However, the moleculesinvolved in this intercellular communication are currently unknown.Human embryonic stem cells (ESCs) express in vitro most of humanconnexin genes and form functionally-competent gap junction channels(Todorova et al., 2008; and Huettner et al., 2006), suggesting thatcoupling between ESCs may play a role in coordinating cellular responsesthat maintain pluripotency or stimulate differentiation.

The possibility of miR traffic through gap junction channels hasprovided an additional level of complexity to the notion ofintercellular communication. We have demonstrated that CSCs and theircommitted progeny vary in miR profiling (Example 1) and this differenceis the prerequisite for an efficient transfer of miRs from the donor tothe recipient cell. The translocation of miR-499 from cardiomyocytes toCSCs imposes significant changes in gene expression in the primitivecell. In this regard, miRs are attractive candidates for the control ofstem cell self-renewal and fate decision, because of their ability toregulate simultaneously many targets providing a way for the coordinatedcontrol of multiple genes and the rapid repression of severaltranscripts (Alvarez-Garcia and Miska, 2005; Chapman and Carrington,2007; and Chu and Rana, 2007). During differentiation, hCSCs have todownregulate stem cell maintenance genes and activate lineage-specificgenes (Beltrami et al., 2003; Urbanek et al., 2005; Linke et al., 2005;Smith et al., 2007; and Bearzi et al., 2007). We have identified targetgenes of miR-499, including Sox5, Sox6 and Rod1, that may need to berepressed to allow lineage specification and determination of hCSCs(Example 2). Thus, hCSC differentiation into myocytes and theiracquisition of the adult phenotype may be regulated by the surroundingcells by the translocation of miR-499 through gap junctions.

Two series of experiments were performed to test whether miR-499 couldtraverse gap junctions. In a first series of experiments, C2C12myoblasts, which express miR-499 (FIG. 6A), were co-cultured withrecipient hCSCs. The presence of miR-499 in hCSCs was documented byquantitative fluorescence in situ hybridization (Q-FISH) utilizing aLocked-Nucleic Acid (LNA) probe which forms a stable complex with thetarget molecule. After 24 hours, the majority of hCSCs, which arerecognized by the expression of c-kit on their plasma membrane,contained miR-499 (FIG. 6B,C). The presence of connexin 43 at theinterface between C2C12 myoblasts and hCSCs indicates the formation ofgap junctions.

In a second series of experiments, a reporter assay was developed tomeasure the functional competence of miR-499 in hCSCs after itstranslocation from neighboring donor cells. Distinct populations ofhCSCs were prepared. One pool of hCSCs served as donor cells and wastransfected with an expression vector carrying miR-499 under the controlof the CMV promoter (CMV-miR-499); hCSCs transfected with empty plasmid(CMV-blank) were used as negative control donor cells. A second pool ofhCSCs, which served as recipient cells, was transfected with a reporterplasmid carrying the luciferase coding sequence and the 3′-UTR of theSox6 gene (see Example 2). Donor and recipient cells were co-culturedfor 3 days in the absence or presence of the gap junction inhibitor18α-Glycyrrhetinic Acid (α-GA) (Wolvetang et al., 2007; Davidson et al.,1986; and Takeda et al., 2005). A β-gal-expressing plasmid was employedto normalize luciferase activity. Luciferase activity was found to besignificantly decreased in recipient cells co-cultured with donor cellscarrying the miR-499 plasmid when the hCSCs were exposed to α-GA (FIG.7). The data from these two series of experiments suggest thatfunctional mature miR-499 translocate into hCSCs through gap junctionchannels made by connexin 43. The observation of in vitro gap junctionformation between CSCs and neighboring cells is consistent withobservations made in the human heart in situ and following the injectionof hCSCs in the infarcted mouse or rat heart (FIG. 8; Bearzi et al.2007; and Hosoda et al. 2008).

Specific Methods

Q-FISH for miR-499. A digoxygenin-labeled Locked Nucleic Acid (LNA)probe (Exiqon) complementary to mature miR-499 was utilized. hCSCs werefixed in 4% paraformaldehyde. After washing in RNase free PBS, cellswere treated with proteinase K (500 ng/ml) followed by incubation in0.2% glycine for 30 sec and washing with RNase-free water. Samples werepre-hybridized for 2 hours in hybridization buffer (50% formamide,5×SSC, 0.4% Tween, 9.2 mM citric acid [ph 6.0], 50 μg/ml heparin, 500μg/ml yeast RNA). Cells were hybridized overnight in the presence of 20nM digoxigenin-labeled probe at 21° C. Samples were washed twice in2×SSC at 37° C. followed by high stringency wash in 50% formamide, 2×SSCat hybridization temperature (Bearzi et al. 2007; and Rota et al. 2007).Immunological detection was carried out with anti-digoxigenin Fabconjugated to rhodamine. Negative controls consisted of omission of theLNA probe and use of a scrambled probe that had very low homology withthe target sequence. Adult and neonatal myocytes were used as positivecontrols.

MiR-499 transfer. Three approaches are employed to demonstrate thatfunctionally competent miR-499 translocates from neighboring cells tohCSCs via gap junctions.

a) Real-time transfer of miR-499. Translocation of miR-499 through gapjunctions is studied in living cells by two-photon microscopy. Thus, welabeled the 5′-side of mature miR-499 (21 nucleotides) with thefluorescent dye Cy3. 3T3 fibroblasts are transfected with Cy3-miR-499and used as donor cells; EGFP-positive hCSCs are employed as recipientcells. Cy3-miR-499 is utilized at a final concentration of 30 nM inOPTI-MEM (Invitrogen) containing 8 μl of the transfection agent NeoFx(Applied Biosystems). Following 10 minutes of incubation, growth medium(DMEM, 10% FBS) is placed in 60-mm Petri dishes in which 3T3 cells(5×10⁵ cells/dish) are plated overnight. The following day 3T3 cells arecarefully washed with PBS to remove free Cy3-miR-499 and fresh medium isadded. EGFP-positive hCSCs (5×10⁵ cells/dish) are co-cultured with 3T3cells in the presence of Alexa647-conjugated connexin 43 antibody. Onehour later, Petri dishes are placed under the stage of a two-photonmicroscope and studied for 8 hours. Images are taken 20 min apart.Alexa647-conjugated connexin 43 antibody allows the detection of theexpression of connexin 43 at the interface between adjacent cells inliving cells. Since Cy3-miR-499 cannot leave the cells, the presence ofred fluorescence in EGFP-positive hCSCs is indicative of the transfer ofmiR-499 through gap junctions from 3T3 cells. This is confirmed by theuse of the gap junction inhibitor α-GA, 10 μM. At the end of theexperiment, EGFP-positive hCSC are sorted by FACS and RNA is extractedusing mirVana kit. Quantitative RT-PCR for miR-499 (see Example 2 forspecific methods) is performed to establish the translocation offull-length miR-499 through gap junctions. hCSCs co-cultured withnon-transfected 3T3 cells are used to assess endogenous miR-499.

b) Translocation of full-length miR-499. Neonatal rat ventricularmyocytes are employed as donor cells and EGFP-positive hCSCs asrecipient cells. Co-culture of myocytes and hCSCs is done in 4-wellculture slides at a ratio of 10:1. Three days later, cells are fixed toperform Q-FISH for miR-499 (see methods above). In an additional set ofexperiments, at the end of the 3-day period, EGFP-positive hCSCs aresorted by FACS and utilized for quantitative RT-PCR. Again, the gapjunction inhibitor α-GA is used to confirm that miR-499 translocationoccurs through gap junctions.

c) Translocation of functionally competent miR-499. 3T3 fibroblasts aretransfected with a plasmid in which a murine genomic DNA fragment of 254bp including miR-499 was cloned downstream of the CMV promoter(CMV-miR-499). hCSCs are transfected with reporter plasmids containingthe 3′-UTR sequences of the genes Sox5, Sox6 and Rod1 ligated at aposition downstream the luciferase coding sequence (see Example 2 forspecific methods). 3T3 cells overexpressing miR-499 are employed asdonor cells and hCSCs expressing luciferase as recipient cells. Donor3T3 cells are plated at a density of 2×10⁴ cells in each well of a6-well dish and transfected with 1 μg of CMV-miR-499 or CMV-blank.Recipient hCSCs are plated at a density of 5×10³ cells in each well of a6-well dish and transfected with 0.9 μg each of CMV-Luci-Sox5-UTR,CMV-Luci-Sox6-UTR or CMV-Luci-Rod1-UTR. A CMV-β-Gal plasmid, 0.1 μg, isused for normalization of luciferase activity. Six hours later, cellsare washed in PBS three times. Recipient transfected cells aretrypsinized and plated together with donor cells at a ratio of 4:1 for 4days. Cells are incubated in lysis buffer and luciferase activity ismeasured. hCSCs transfected with the same reporter plasmids but culturedwith non-transfected 3T3 are used as baseline. Downregulation ofluciferase activity in co-cultured cells is indicative of translocationof miR-499 to hCSCs. The gap junction inhibitor α-GA will be added in aseparate set of experiments to confirm the translocation of miR-499 isvia the gap junctions.

Example 4 MiR-499 Promotes the Differentiation of Cardiac Stem Cellsinto Cardiomyocytes

In this example, two approaches are employed to document the function ofmiR-499, Sox6 and Rod1 in rat and human CSCs. In a first series ofexperiments, hCSCs were transfected with an expression vector carryingmiR-499 under the control of the CMV promoter (CMV-miR-499) and markersof cell proliferation and myocyte differentiation were evaluated threedays later by quantitative RT-PCR and immunocytochemistry. Followingtransfection, the quantity of miR-499 in hCSCs increased 3,000-fold(FIG. 9A, B). BrdU incorporation decreased 60% in hCSCs transfected withmiR-499 compared to hCSCs transfected with an empty vector (FIG. 9C).hCSCs expressing miR-499 also displayed a marked upregulation of themyocyte-specific transcription factors Nkx2.5 and MEF2C at the mRNAlevel (FIG. 9D). In a second series of experiments, Sox6 and Rod1 wereselectively blocked in rat CSCs with siRNA technique (see Example 2 fordescription of Sox6- and Rod-1 siRNA). When CSCs were transfected withSox6-siRNA, mRNA expression of Sox6 was 86% lower than innon-transfected controls (FIG. 9E). Similarly, Rod1 mRNA was 50% lowerwhen CSCs were transfected with Rod1-siRNA (FIG. 9E). In both cases,three days after siRNA transfection, the fraction of CSCs committed tothe myocyte lineage increased significantly in agreement with thebiochemical results. In comparison with CSCs exposed to random siRNA,the percentage of Nkx2.5-positive and MEF2C-positive cells increased2-3-fold in the presence of siRNA against Sox6 and Rod1 (FIG. 9F). Thesedata suggest that Sox6 and Rod1 are novel target genes of miR-499 andthat inhibition of the expression of Sox6 and Rod1 promotes thedifferentiation of CSCs into cardiomyocytes.

Specific Methods

Function of miR-499 in hCSCs. The effects of miR-499 on the growth ofhCSCs was established by transfection with an expression plasmidcarrying miR-499. Proliferation and differentiation of hCSCs wasevaluated by immunocytochemistry, quantitative RT-PCR and Westernblotting.

a) Transfection of hCSCs with expression plasmid CMV-miR-499. Three μlof transfection reagent XP-1 (Applied Biosystems) was added to 100 μl ofOPTI-MEM and after a 10 min-incubation was mixed to the plasmidsCMV-miR-499 or CMV-blank, 1 μg. After 10 min, the solution containingthe plasmids was added to hCSCs in vitro. The medium was removed after 6hours and replaced with fresh medium. Cells were cultured for threedays. BrdU, 1 μg/ml, was added twice a day during the duration ofexperiment. Cells were employed for immunocytochemistry and molecularbiology studies.

b) Immunocytochemistry. Transfected cells were fixed in 4%paraformaldehyde. To assess the degree of proliferation of transfectedhCSCs, samples were stained with BrdU monoclonal antibody. The fractionof hCSCs positive for the cell cycle markers Ki67 and MCM5 was alsomeasured. To evaluate the lineage commitment of hCSCs in culture,antibodies for transcription factors and cytoplasmic proteins specificfor myocytes were included: Nkx2.5, MEF2C, GATA4, α-sarcomeric actin,α-cardiac actinin, troponin I, troponin T, and cardiac myosin heavychain (Kajstura et al., 1998; Beltrami et al., 2001; Limana et al.,2003; Urbanek et al., 2003; Urbanek et al., 2005; and Beltrami et al.,2003). The presence of apoptotic cells was quantitatively measured byTdT assay and hairpin 1 probe labeling (Urbanek et al., 2005; and Rotaet al., 2006).

c) Luciferase reporter assay. This assay required co-transfection ofhCSCs with CMV-miR-499 and luciferase reporter plasmids for Sox5, Sox6or Rod1. hCSCs were co-transfected with 0.1 μg of luciferase reporterplasmid, 0.1 μg of β-gal control plasmid, and CMV-miR-499 or CMV-blank.Different amounts of CMV-miR-499 varying from 0.1 μg to 0.8 μg were usedto confirm that the translational inhibition of luciferase isdose-dependent. A luciferase reporter plasmid without the addition of3′-UTR was employed as a negative control (Boni et al., 2008).

d) Quantitative RT-PCR. Total RNA was extracted from CMV-miR-499 andCMV-blank transfected hCSCs with mirVana miRNA isolation kit (AppliedBiosystems) and employed for the measurement of miR-499 expression aswell as the quantity of the transcripts for Sox5, Sox6, Rod1 (the targetgenes of miR-499) and Nkx2.5, MEF2C, myocardin and GATA4 (myocytemarkers). Human myocardium was employed as a positive control. cDNA formRNAs was obtained from 1 μg total RNA in a 20 μl reaction containingfirst strand buffer, 0.5 mM each of dTTP, dATP, dGTP and dCTP togetherwith 200 U of Superscript III (Invitrogen), 40 U of Rnase inhibitor(Rnasin Plus, Promega) and 50 pmole of oligo(dT)15 primer (Bearzi etal., 2007; and Gonzalez et al., 2008). This mixture was incubated at 42°C. for 2 hours. Subsequently, real-time RT-PCR was performed with thefollowing primers designed using the Primer Express v2.0 (AppliedBiosystems) or Vector NTI (Invitrogen) software. “F” designates theforward primer and “R” designates the reverse primer.

hSox5-F: 5′-AGC TTT TTG CCA TCC ACC AGG-3′ hSox5-R: 5′-ATA ACA GGC ATCCCA GGC TCT-3′ hSox6-F: 5′-CCG ACA TGC ATA ACT CCA ACA T-3′ hSox6-R:5′-CGG TCG GGG TTT GTA TTT ATA GTT-3′ hRod1-F: 5′-GTC CAA ACA TCA AGCAGT ACA GC-3′ hRod1-R: 5′-AGA TCA TCC ACT GTA ACA GAA GGG-3′ hNkx2.5-F:5′-TCT ATC CAC GTG CCT ACA GCG-3′ hNkx2.5-R: 5′-GCT CCA GCT CAT AGA CCTGCG-3′ hMEF2C-F: 5′-TGG TGT AAC ACA TCG ACC TCC AAG-3′ hMEF2C-R: 5′-TCAAGT TAC CAG GTG AGA CCA GCA-3′ hGata4F: 5′-GGA GAT GCG TCC CAT CAAGAC-3′ hGata4-R: 5′-GGA GAC GCA TAG CCT TGT GG-3′ hMyocardin-F: 5′-AGAAGG GCA CAG GGT CTC CT-3′ hMyocardin-R: 5′-ACT CCG GGT CAT TTG CTG CT-3′hActb-F: 5′-AAG ATC AAG ATC ATT GCT CCT CCT G-3′ hActb-R: 5′-CGG ACT CGTCAT ACT CCT GCT-3′

The 7300 Real-Time PCR system (Applied Biosystems) was employed forquantitative RT-PCR that was performed in duplicate. In each case, cDNAsynthesized from 50 ng total RNA was used. cDNA was combined with PowerSYBR Green master mix (Applied Biosystems) and 0.5 μM each of forwardand reverse primers. Cycling conditions were as follows: 95° C. for 10min followed by 40 cycles of amplification (95° C. denaturation for 15sec, and 60° C. annealing-extension for 1 min). The melting curve wasthen obtained. To avoid the influence of genomic contamination, forwardand reverse primers for each gene were located in different exons.Reactions containing cDNA generated without reverse transcriptase andreactions with primers alone were also included. PCR efficiency wasevaluated using a standard curve of four serial dilution points.Quantified values were normalized against the input determined by thehousekeeping gene β-actin (Actb). Real-time PCR products were run on 2%agarose/1× TBE gel. Amplified fragments were cut out and DNA wasextracted using QIAquick Gel Extraction kit (Qiagen). DNA was eluted in30 μl of 10 mM Tris buffer (pH 8.5), and amplified by Platinum Blue PCRSupermix (Invitrogen) in the presence of 260 nM of the forward andreverse primers utilized for real-time PCR. PCR reaction was carried outin Eppendorf Mastercycler (Bearzi et al., 2007; and Gonzalez et al.,2008). Cycling conditions were as follows: 94° C. for 2 min followed by35 cycles of amplification (94° C. denaturation for 20 sec, 60° C.annealing for 30 sec, 72° C. elongation for 20 sec) with a finalincubation at 72° C. for 3 min. After purification using QIAquick PCRPurification kit (Qiagen), samples were submitted to the DNA SequencingFacility (Dana Farber, Boston).

e) Western Blotting. Proteins from CMV-miR-499 and CMV-blank transfectedhCSCs were extracted using M-PER Mammalian Protein Extraction Reagent(Pierce Biotechnology) and protease inhibitors. Protein concentrationwas measured by Bradford assay (Bio-Rad). Equivalents of 30 μg proteinwas separated on 8-12% SDS-PAGE. Proteins were subsequently transferredonto nitrocellulose membranes, blocked with 5% BSA or 5% dry skim milkin Tris-saline buffer with 0.1% Tween20 (TBST) for 1 h at roomtemperature, and exposed to rabbit polyclonal anti-Sox5 (Santa Cruz),rabbit polyclonal anti-Sox6 (Sigma), goat polyclonal anti-Rod1 (SantaCruz), rabbit polyclonal anti-Nkx2.5 (Santa Cruz) and goat polyclonalanti-MEF2C diluted 1:2000-1:200 in TBST overnight at 4° C.HRP-conjugated IgG was used as secondary antibodies (PierceBiotechnology). Proteins were detected by chemiluminesence (SuperSignalWest Femto Maximum Sensitivity Substrate, Pierce Biotechnology) and ODwas measured (Urbanek et al., 2005a; Urbanek et al., 2005b; Boni et al.2008; and Gonzalez et al., 2008). Loading conditions were determined bythe expression of β-actin (Sigma). Human myocardium was employed as apositive control.

Example 5 MiR-499 may Promote CSC Differentiation by Activation of theWnt/β-Catenin Pathway

Numerous downstream effector pathways may mediate the function of Sox5,Sox6 and Rod1. We have elected to test whether the preservation of theprimitive state of hCSCs is regulated by inhibition of the Wnt pathwaywhile the maturation of hCSCs and the formation of functionallycompetent myocytes require the stabilization of β-catenin by Wntligands. Specifically, active Wnt is believed to be essential for thelate stages of maturation of hCSCs into myocytes and the transition fromthe highly proliferative state of transit amplifying cells to thequiescence of terminally differentiated cardiomyocytes.

Wnts are a family of secreted proteins composed of numerous isoforms(Willert et al., 2003; and Nusse et al., 2003). Two types of receptorsmediate the Wnt activity: the Frizzled receptor that is a seventransmembrane pass-protein and the low-density lipoproteinreceptor-related proteins (LRP) (Wang and Malbon, 2003; and Fujino etal., 2003). The main downstream event of the Wnt cascade is thestabilization of β-catenin (Daniels et al., 2001). In the absence ofWnt, β-catenin is phosphorylated by GSK-3β and in part degraded throughthe ubiquitin-proteasome pathway. However, part of β-cateninparticipates in the generation of adherens junctions with E-cadherin,mediating cell-to-cell adhesion and hCSC homing and quiescence withinthe myocardium (Urbanek et al., 2006; and Gottardi and Gumbiner, 2001).Conversely, when β-catenin is stabilized by Wnt and accumulates in thecytoplasm, a significant portion of β-catenin is translocated to thenucleus where it confers the property of transcription factors to theLef/TCF family of DNA binding proteins (Huber et al., 1996). Lef/TCFproteins associate with a number of chromatin-remodeling factors thatactivate or repress target genes (Hsu et al., 1998; and Novak andDedhar, 1999).

During development, the Wnt/β-catenin pathway plays a biphasic role,positive and negative, in controlling differentiation of cardiomyocytes(Naito et al., 2006; and Kwon et al., 2007). At different stages ofcardiac morphogenesis, this axis has distinct and even opposingfunctions, playing a critical inhibitory role in the initial formationof cardiovascular progenitors and later acting as a positive signal forcell commitment (Naito et al., 2006; Kwon et al., 2007; and Nakamura etal., 2003). Both canonical and non-canonical Wnt have been shown tofavor the commitment of progenitor cells to myocytes (Koyanagi et al.,2005; and Koyanagi et al., 2007). The upregulation of miR-499 in hCSCsmay repress Sox5 and Sox6 favoring the function of Sox7, Sox17 andSox18, which in turn activate the Wnt/β-catenin pathway, initiatingmyocyte differentiation. By applying siRNA technique, it has beendocumented that Sox17 promotes the expression of cardiogenictranscription factors, such as Nkx2.5, Mef2C, Tbx5 and myocardin (Liu etal., 2007). The members of the SoxF subfamily, i.e. Sox7, Sox17 andSox18, may have redundant roles in cardiovascular development (Sakamotoet al., 2007); however, Sox5 and Sox6 may antagonize the function of thethree SoxF proteins. During endodermal development, Sox17 is bound toβ-catenin and the formation of this complex potentiates thetranscriptional activation of target genes (Liu et al., 2007).

This Example outlines experiments that test the function of miR-499target genes (e.g. Sox5, Sox6, and Rod1) in hCSCs and their interactionwith Wnt/β-catenin pathway. In a first series of experiments, theeffects of Sox5, Sox6 and Rod1 on the growth of hCSCs are established bya gain and loss of function approach. Transfection of hCSCs withSox5-siRNA, Sox6-siRNA and Rod1-siRNA is expected to promotedifferentiation of hCSCs in a manner similar to mi-R499 overexpression.However, transfection with single siRNA allows us to establish theconsequences of the repression of each gene on proliferation andcommitment of hCSCs. Opposite results are expected when hCSCs aretransfected with expression plasmids carrying Sox5, Sox6 and Rod1 (seeExample 2 for description of expression plasmids) with preservation ofthe undifferentiated state of hCSCs being observed. Transfected cellsare employed for immunocytochemistry and molecular biology studies (seeExample 4).

In a second series of experiments, the effects of overexpressing miR-499in hCSCs on Sox17 and its interaction with β-catenin will be examined.To demonstrate the physical interaction between β-catenin and Sox17(Sinner et al., 2004) in nuclei of hCSCs overexpressing miR-499,immunoprecipitation and Western blotting are performed (Urbanek et al.,2005a; Urbanek et al., 2005b; Boni et al. 2008; and Gonzalez et al.,2008). Nuclear protein lysates are obtained from hCSCs overexpressingmiR-499 and pulled-down with rabbit anti-β-catenin polyclonal antibody(Santa Cruz). Western blotting is performed with mouse anti-Sox17monoclonal antibody (R&D Systems), 1:2000, to detect the proteincomplex. The presence of a complex between Sox17 and β-catenin in thenucleus of cells overexpressing miR-499 is expected.

Example 6 Myocardial Regeneration by Cardiac Stem Cells OverexpressingmiR-499

The objective of this Example is to test whether the in vitroobservations concerning the positive role of miR-499 on hCSCdifferentiation have a functional counterpart in vivo. To address thisquestion, hCSCs overexpressing miR-499 will be administered to theinfarcted heart to determine if myocardial regeneration with formationof mature functionally competent cardiomyocytes is induced.

As expected, downregulation of miR-499 may interfere with the functionof numerous cardiomyogenic factors, such as SoxF proteins and theWnt-β-catenin pathway. In differentiating hCSCs, a limited or delayedupregulation of miR-499 is expected to be associated with the arrest ofmyocyte differentiation at an early stage of commitment. Under thiscondition, a large number of transient amplifying myocytes is formed.These cells have high proliferative capacity, are small in size andcontain a little amount of myofibrils located at the periphery of thecytoplasm. Transit amplifying myocytes are characterized by a prolongedexpression of the early myocyte transcription factor Nkx2.5, which caninterfere with the appearance of late markers of cardiomyogenesis suchas GATA4 (Boni et al., 2008). This cellular behavior would conform to amodel of differentiation delay in which the persistence of Sox5, Sox6and Rod1 opposes the progression of myocyte maturation. Forcedexpression of miR-499 in hCSCs, which would downregulate Sox5, Sox6, andRod1 favoring myocyte maturation, may enhance the regenerative capacityof this pool of primitive cells favoring their clinical implementation.

hCSCs are infected with a lentiviral vector carrying miR-499 and areinjected in the border zone of immunosuppressed infarcted rats. Thisstrategy is implemented in an attempt to counteract the defectivedifferentiation of hCSCs (Bearzi et al., 2007; and Hosoda et al., 2008),which may be mediated by the lack of miR-499 in the implanted hCSCs.This molecular modification may promote the transition of hCSCs fromearly to late myocyte differentiation.

Infarcted animals treated with EGFP-labeled hCSCs overexpressing miR-499are sacrificed at different time points after coronary ligation and cellimplantation and EGFP-positive myocytes are isolated from theregenerating myocardium to determine their molecular andimmunocytochemical characteristics (Urbanek et al., 2005b; Bearzi etal., 2007; Gonzalez et al., 2008; and Rota et al., 2007). Also, themechanical and electrical behavior of the regenerated myocytes ismeasured together with calcium transients (Beltrami et al., 2003;Urbanek et al., 2005b; Rota et al., 2007a; and Rota et al., 2007b).These molecular, immunocytochemical and functional data allow us todefine whether the presence of miR-499 conditions the ability of hCSCsto promote myocardial regeneration after infarction and whether therestored myocardium acquired adult characteristics. Upregulation ofmiR-499 in hCSCs may enhance the extent of the regenerative responsepromoting a faster recovery. The ability to modulate the quantity andtiming of miR-499 expression in hCSCs may be essential for therapiesthat aim to balance the expansion of the myocyte progenitor cell pooltogether with their differentiation.

Specific Methods

Lentivirus-miR-499. For the in vivo studies, a lentiviral vectorcarrying miR-499 and EGFP is generated to obtain stable infection ofhCSCs prior to their injection into the infarcted rat heart. The humangenomic DNA fragment of the hMyh7b intron 20 including the hsa-miR-499is amplified by PCR utilizing the following primers:

hsa-stem Eco1-F: 5′-CAA GGG AAT TCC CCA TCT GGG AGA CAG ACC CTC-3′hsa-stem Eco1-R: 5′-GAT GGG AAT TCC TTC GCT GTC TCC CAT CAC CAC-3′

The PCR product is ligated into a CGW plasmid vector carrying EGFP. Thedirection of insertion is confirmed by sequencing. HEK293T/17 cellscultured in DMEM, 10% FBS, are used as packaging cells for lentiviralproduction. Four plasmids are mixed and diluted in 1.5 ml OPTI-MEM:gag/pol, 6.5 μg, VSVG, 3.5 μg, pRSV-rev, 2.5 μg, and CGW-miR-499, 10 μg.Plasmids are then combined with Lipofectamine 2000 (Invitrogen). Twentyminutes later, this mixture is added to culture dishes. Six hours later,the medium is removed and fresh medium added. Medium is collected at 24and 48 hours, and frozen after filtration.

Similar methods are used for preparation of lentiviral vectors carryingdifferent microRNAs, such as miR-1, miR-133a, and miR-133b. For example,the following primers are used to amplify each of the specific miRNAsfrom human genomic DNA:

hsa-miR-1-Eco1-F: 5′-GAC GGG AAT TCA CGT AGA AAG AAG CAA GAG CT-3′hsa-miR-1-Eco1-R: 5′-TAC CAG AAT TCT ACA TTA GTA AGC TGA ATG TTT C-3′hsa-miR-133a-Eco1-F: 5′-GAA GCG AAT TCT CCA TCG GGA CTG CTT GGT GGA G-3′hsa-miR-133a-Eco1-R: 5′-CTC AGG AAT TCA CTT ACT TGG AGC TGA CCA CGT-3′hsa-miR-133b-Eco1-F: 5′-AAT GCG AAT TCT TTT TGC ATT ACA GGC TTA GAC-3′hsa-miR-133b-Eco1-R: 5′-TCT CTG AAT TCC TGG GAG CAT AAG AAT ATG GTG-3′

Following EcoR1 digestion, the PCR products are ligated into a CGWplasmid. The same procedures as described above for lentiviral vectorscarrying miR-499 are followed to obtain the lentivirus with the desiredmicroRNA.

Cell preparation. hCSCs are isolated from 5 myocardial samples obtainedfrom male patients and transduced with a lentiviral vector expressingmiR-499 and EGFP. An empty lentivirus obtained from CGW vector withoutinsertion of miR-499 is used as a control.

Animals. Myocardial infarction is induced in female Fischer 344 rats at3 months of age by permanent coronary artery occlusion. Permanentcoronary artery occlusion is performed in rats anesthetized withketamine (150 mg/kg body weight, i.p.), acepromazine (1.0 mg/kg bodyweight, i.p.), and xylazine (6 mg/kg body weight, i.p.). The thorax isopened via the third costal space, the atrial appendage elevated, theleft coronary artery is located, and a silk braided suture (6-0) isinserted around the vessel near the origin and the artery occluded.hCSCs are injected shortly after coronary artery inclusion. Fourintramyocardial injections of 10,000 cells each are made at the twoopposite sides of the border zone of the infarct. The chest is closedand pneumothorax reduced by negative pressure. Immunosuppressivetreatment consists of cyclosporine (10 mg/kg body weight, i.p.).

One group of animals receives miR-499-overexpressing hCSCs and one groupis injected with hCSCs infected with the empty vector. In both cases,hCSCs will be EGFP-positive. Myocardial regeneration is evaluated 3months later. Immunosuppression with cyclosporin A is initiated at thetime of cell administration and maintained throughout (Bearzi et al.,2007). Similarly, Alzet microsmotic pumps (2ML4) that release BrdUcontinuously for 4 weeks is implanted every month to determinedifferences in growth rates between animals treated with the differentpopulations of hCSCs.

Echocardiography. Echocardiography is performed two days after coronaryocclusion and cell implantation. This analysis is repeated at 2 and 4weeks and then monthly (Bearzi et al., 2007; Gonzalez et al., 2008).

Ventricular hemodynamics. Animals are anesthetized and the right carotidartery cannulated with a microtip pressure transducer catheter (MillarSPR-240). The catheter is advanced into the left ventricle for theevaluation of the ventricular pressures and + and − dP/dt. Afour-channel 100 kHz 16-bit recorder with built-in isolated ECGamplifier (iWorks IX-214) is used to store signals in a computerutilizing LabScribe software. For morphological and immunohistochemicalstudies, the heart is arrested in diastole with CdCl₂ and the myocardiumfixed by perfusion of the coronary vasculature with formalin. The leftventricular chamber is fixed at a pressure equal to the in vivo measuredLVEDP. This procedure is important for the acquisition of anatomicaldata of heart size and shape under comparable conditions in all animals.For biochemical and physiological studies, transplanted rats are usedfor the isolation of the EGFP-positive progeny derived from the injectedcells. The heart is minced in incubation buffer containing collagenaseand EGFP-labeled cells are sorted by FACS.

Detection of EGFP and human genes. Real-time RT-PCR: RNA is extractedand reverse transcribed into cDNA. Specific primers are designed forEGFP, Nkx2.5, MEF2C, myocardin, GATA4 and SRF.

Immunocytochemistry of myocardial regeneration. This analysis includesexamination of myocyte specific markers: Nkx2.5, MEF2C, GATA4,α-sarcomeric actin, α-cardiac actinin, troponin I, troponin T, andcardiac myosin heavy chain protein, connexin 43 and N-cadherin. Thepresence of EGFP and Alu is assessed in the differentiating myocytes toestablish their human origin. Human-specific Alu repeat sequences aredetected by in situ hybridization with a probe (Biogenex, San Ramon,Calif.). For detailed methods, see Bearzi et al., 2007.

Cardiac anatomy, myocyte volume and number. After paraffin-embedding,three tissue sections equal in thickness and including the entire leftventricle (LV) and interventricular septum from the base to the apex ofthe heart, is obtained and stained with hematoxylin and eosin. Themidsection is used to evaluate LV wall thickness and chamber diameter.Chamber volume is then calculated (Rota et al., 2007a; Gonzalez et al.,2008; and Rota et al., 2007b). Infarct size is assessed by the fractionof myocytes lost from the LV (Beltrami et al., 2003; Urbanek et al.,2005b; and Bearzi et al., 2007). The volume of regenerated myocardium isdetermined by measuring in each of the three sections the area occupiedby the restored tissue and section thickness. The product of these twovariables yields the volume of tissue repair in each section. Values inthe three sections are added, and the total volume of formed myocardiumis obtained. The volume of 150 newly formed myocytes is measured in eachheart. Only longitudinally oriented cells with centrally located nucleiare included. The length and diameter across the nucleus is collected ineach myocyte to compute cell volume, assuming a cylindrical shape(Urbanek et al., 2005b; and Bearzi et al., 2007; and Rota et al.,2007b).

Cell fusion. To evaluate whether cell fusion is involved in theformation of EGFP-positive myocytes, the presence of rat and human sexchromosomes is measured in EGFP-positive cells. This is done becausemale hCSCs are injected in female infarcted hearts. Sections arepreheated and exposed to enzymatic digestion. After dehydration withethanol, sections and Rat Chromosome X and Y Paint probe (Cambio) aredenatured and hybridized. Nuclei are stained with DAPI (Urbanek et al.,2005b; Bearzi et al., 2007; Rota et al., 2007b; and Tillmanns et al.,2008).

Cellular physiology. EGFP-positive myocytes, the progeny of theimplanted hCSCs, are obtained by enzymatic digestion from theinfarcted-regenerated region of the heart. The functional competence ofthese cells is established. Mechanics and Ca2+ transients: Myocytes arestimulated by platinum electrodes. Changes in cell length are quantifiedby edge tracking. Simultaneously, Fluo 3-fluorescence is excited at 488nm. Different rates of stimulation and different extracellular Ca2+concentrations are examined (Beltrami et al., 2003; Urbanek et al.,2005b; and Rota et al., 2007b). Electrophysiology: Data are collected bymeans of whole cell patch-clamp technique in voltage- and current-clampmode and by edge motion detection measurements. Voltage, time-dependenceand density of L-type Ca2+ current is analyzed in voltage-clamppreparations. Additionally, the T-type Ca2+ current is assessed; thiscurrent is restricted to young developing myocytes (Rota et al., 2007b).Also, the relationship between cell shortening and action potentialprofile is determined in current-clamp experiments (Rota et al., 2007a;and Rota et al., 2007b).

REFERENCES

-   1. Anversa P, Leri A, Beltrami C A, Guerra S, Kajstura J: Myocyte    death and growth in the failing heart. Lab Invest. 78:767-86, 1998-   2. Anversa P, Leri A, Kajstura J, Nadal-Ginard B: Myocyte growth and    cardiac repair. J Mol Cell Cardiol. 34:91-105, 2002-   3. Anversa P, Leri A, Kajstura J: Cardiac regeneration. J Am Coll    Cardiol. 47:1769-76, 2006-   4. Kajstura J, Leri A, Finato N, Di Loreto C, Beltrami C A, Anversa    P: Myocyte proliferation in end-stage cardiac failure in humans.    Proc Natl Acad Sci USA. 95:8801-5, 1998-   5. Beltrami A P, Urbanek K, Kajstura J, Yan S M, Finato N, Bussani    R, Nadal-Ginard B, Silvestri F, Leri A, Beltrami C A, Anversa P:    Evidence that human cardiac myocytes divide after myocardial    infarction. N Engl J Med. 344:1750-7, 2001-   6. Limana F, Urbanek K, Chimenti S, Quaini F, Leri A, Kajstura J,    Nadal-Ginard B, Izumo S, Anversa P: bcl-2 overexpression promotes    myocyte proliferation. Proc Natl Acad Sci USA. 99:6257-62, 2002-   7. Urbanek K, Quaini F, Tasca G, Torella D, Castaldo C, Nadal-Ginard    B, Leri A, Kajstura J, Quaini E, Anversa P: Intense myocyte    formation from cardiac stem cells in human cardiac hypertrophy. Proc    Natl Acad Sci USA. 100:10440-5, 2003-   8. Urbanek K, Torella D, Sheikh F, De Angelis A, Nurzynska D,    Silvestri F, Beltrami C A, Bussani R, Beltrami A P, Quaini F, Bolli    R, Leri A, Kajstura J, Anversa P: Myocardial regeneration by    activation of multipotent cardiac stem cells in ischemic heart    failure. Proc Natl Acad Sci USA. 102:8692-7, 2005a-   9. Beltrami A P, Barlucchi L, Torella D, Baker M, Limana F, Chimenti    S, Kasahara H, Rota M, Musso E, Urbanek K, Leri A, Kajstura J,    Nadal-Ginard B, Anversa P: Adult cardiac stem cells are multipotent    and support myocardial regeneration. Cell. 114:763-76, 2003-   10. Oh H, Bradfute S B, Gallardo T D, Nakamura T, Gaussin V, Mishina    Y, Pocius J, Michael L H, Behringer R R, Garry D J, Entman M L,    Schneider M D: Cardiac progenitor cells from adult myocardium:    homing, differentiation, and fusion after infarction. Proc Natl Acad    Sci USA. 100:12313-8, 2003-   11. Pfister O, Mouquet F, Jain M, Summer R, Helmes M, Fine A,    Colucci W S, Liao R: CD31- but Not CD31+ cardiac side population    cells exhibit functional cardiomyogenic differentiation. Circ Res.    97:52-61, 2005-   12. Urbanek K, Rota M, Cascapera S, Bearzi C, Nascimbene A, De    Angelis A, Hosoda T, Chimenti S, Baker M, Limana F, Nurzynska D,    Torella D, Rotatori F, Rastaldo R, Musso E, Quaini F, Leri A,    Kajstura J, Anversa P: Cardiac stem cells possess growth    factor-receptor systems that after activation regenerate the    infarcted myocardium, improving ventricular function and long-term    survival. Circ Res. 97:663-73, 2005b-   13. Linke A, Muller P, Nurzynska D, Casarsa C, Torella D, Nascimbene    A, Castaldo C, Cascapera S, Bohm M, Quaini F, Urbanek K, Leri A,    Hintze T H, Kajstura J, Anversa P: Stem cells in the dog heart are    self-renewing, clonogenic, and multipotent and regenerate infarcted    myocardium, improving cardiac function. Proc Natl Acad Sci USA.    102:8966-71, 2005-   14. Smith R R, Barile L, Cho H C, Leppo M K, Hare J M, Messina E,    Giacomello A, Abraham M R, Marbán E: Regenerative potential of    cardiosphere-derived cells expanded from percutaneous endomyocardial    biopsy specimens. Circulation. 115:896-908, 2007-   15. Bearzi C, Rota M, Hosoda T, Tillmanns J, Nascimbene A, De    Angelis A, Yasuzawa-Amano S, Trofimova I, Siggins R W, Lecapitaine    N, Cascapera S, Beltrami A P, D'Alessandro D A, Zias E, Quaini F,    Urbanek K, Michler R E, Bolli R, Kajstura J, Leri A, Anversa P:    Human cardiac stem cells. Proc Natl Acad Sci USA. 104:14068-73, 2007-   16. Götz M, Huttner W B: The cell biology of neurogenesis. Nat Rev    Mol Cell Biol. 6:777-88, 2005-   17. Morrison S J, Kimble J: Asymmetric and symmetric stem-cell    divisions in development and cancer. Nature. 441:1068-74, 2006-   18. Watt F M: Epidermal stem cells: markers, patterning and the    control of stem cell fate. Philos Trans R Soc Lond B Biol Sci.    353:831-7, 1998-   19. Jones P H, Watt F M: Separation of human epidermal stem cells    from transit amplifying cells on the basis of differences in    integrin function and expression. Cell. 73:713-24, 1993-   20. Watt F M, Hogan B L: Out of Eden: stem cells and their niches.    Science. 287:1427-30, 2000-   21. Taylor G, Lehrer M S, Jensen P J, Sun T T, Lavker R M:    Involvement of follicular stem cells in forming not only the    follicle but also the epidermis. Cell. 102:451-61, 2000-   22. Wright N A: Epithelial stem cell repertoire in the gut: clues to    the origin of cell lineages, proliferative units and cancer. Int J    Exp Pathol. 81:117-43, 2000-   23. Lansdorp P M: Role of telomerase in hematopoietic stem cells.    Ann NY Acad Sci. 1044:220-7, 2005-   24. Flores I, Benetti R, Blasco M A: Telomerase regulation and stem    cell behaviour. Curr Opin Cell Biol. 18:254-60, 2006-   25. Leri A, Kajstura J, Anversa P: Cardiac stem cells and mechanisms    of myocardial regeneration. Physiol Rev. 85:1373-416, 2005-   26. Ramalho-Santos M, Yoon S, Matsuzaki Y, Mulligan R C, Melton D A:    “Stemness”: transcriptional profiling of embryonic and adult stem    cells. Science. 298:597-600, 2002-   27. Ivanova N B, Dimos J T, Schaniel C, Hackney J A, Moore K A,    Lemischka I R: A stem cell molecular signature. Science. 298:601-4,    2002-   28. Bruno L, Hoffmann R, McBlane F, Brown J, Gupta R, Joshi C,    Pearson S, Seidl T, Heyworth C, Enver T: Molecular signatures of    self-renewal, differentiation, and lineage choice in multipotential    hemopoietic progenitor cells in vitro. Mol Cell Biol. 24:741-56,    2004-   29. Bhattacharya B, Miura T, Brandenberger R, Mejido J, Luo Y, Yang    A X, Joshi B H, Ginis I, Thies R S, Amit M, Lyons I, Condie B G,    Itskovitz-Eldor J, Rao M S, Puri R K: Gene expression in human    embryonic stem cell lines: unique molecular signature. Blood.    103:2956-64, 2004-   30. Alvarez-Garcia I, Miska E A: MicroRNA functions in animal    development and human disease. Development. 132:4653-62, 2005-   31. Chapman E J, Carrington J C: Specialization and evolution of    endogenous small RNA pathways. Nat Rev Genet. 8:884-96, 2007-   32. Chu C Y, Rana T M: Small RNAs: regulators and guardians of the    genome. J Cell Physiol. 213:412-9, 2007-   33. Tijsterman M, Plasterk R H: Dicers at RISC; the mechanism of    RNAi. Cell. 117:1-3, 2004-   34. Gregory R I, Chendrimada T P, Shiekhattar R: MicroRNA    biogenesis: isolation and characterization of the microprocessor    complex. Methods Mol Biol. 342:33-47, 2006-   35. Peters L, Meister G. Argonaute proteins: mediators of RNA    silencing. Mol Cell. 26:611-23, 2007-   36. Tuddenham L, Wheeler G, Ntounia-Fousara S, Waters J,    Hajihosseini M K, Clark I, Dalmay T: The cartilage specific    microRNA-140 targets histone deacetylase 4 in mouse cells. FEBS    Lett. 580:4214-7, 2006-   37. Saetrom P, Snøve O Jr, Rossi J J: Epigenetics and microRNAs.    Pediatr Res. 61:17R-23R, 2007-   38. Chuang J C, Jones P A: Epigenetics and microRNAs. Pediatr Res.    61:24R-29R, 2007-   39. Yu B, Yang Z, Li J, Minakhina S, Yang M, Padgett R W, Steward R,    Chen X: Methylation as a crucial step in plant microRNA biogenesis.    Science. 307:932-5, 2005-   40. Urbanek K, Cesselli D, Rota M, Nascimbene A, De Angelis A,    Hosoda T, Bearzi C, Boni A, Bolli R, Kajstura J, Anversa P, Leri A:    Stem cell niches in the adult mouse heart. Proc Natl Acad Sci USA.    103:9226-31, 2006-   41. Söhl G, Willecke K. Gap junctions and the connexin protein    family. Cardiovasc Res. 62:228-32, 2004-   42. Peters N S: Gap junctions: clarifying the complexities of    connexins and conduction. Circ Res. 99:1156-8, 2006-   43. Loewenstein W R: Junctional intercellular communication: the    cell-to-cell membrane channel. Physiol Rev. 61:829-913, 1981-   44. Neijssen J, Herberts C, Drijfhout J W, Reits E, Janssen L,    Neefjes J: Cross-presentation by intercellular peptide transfer    through gap junctions. Nature. 434:83-8, 2005-   45. Valiunas V, Polosina Y Y, Miller H, Potapova I A, Valiuniene L,    Doronin S, Mathias R T, Robinson R B, Rosen M R, Cohen I S, Brink P    R: Connexin-specific cell-to-cell transfer of short interfering RNA    by gap junctions. J Physiol. 568:459-68, 2005-   46. Wolvetang E J, Pera M F, Zuckerman K S: Gap junction mediated    transport of shRNA between human embryonic stem cells. Biochem    Biophys Res Commun. 363:610-5, 2007-   47. Todorova M G, Soria B, Quesada I: Gap junctional intercellular    communication is required to maintain embryonic stem cells in a    non-differentiated and proliferative state. J Cell Physiol.    214:354-62, 2008-   48. Zhao Y, Samal E, Srivastava D: Serum response factor regulates a    muscle-specific microRNA that targets Hand2 during cardiogenesis.    Nature. 436:214-20, 2005-   49. Zhao Y, Ransom J F, Li A, Vedantham V, von Drehle M, Muth A N,    Tsuchihashi T, McManus M T, Schwartz R J, Srivastava D:    Dysregulation of cardiogenesis, cardiac conduction, and cell cycle    in mice lacking miRNA-1-2. Cell. 129:303-17, 2007-   50. Sayed D, Hong C, Chen I Y, Lypowy J, Abdellatif M: MicroRNAs    play an essential role in the development of cardiac hypertrophy.    Circ Res. 100:416-24, 2007-   51. Yang B, Lin H, Xiao J, Lu Y, Luo X, Li B, Zhang Y, Xu C, Bai Y,    Wang H, Chen G, Wang Z: The muscle-specific microRNA miR-1 regulates    cardiac arrhythmogenic potential by targeting GJA1 and KCNJ2. Nat    Med. 13:486-91, 2007-   52. Carè A, Catalucci D, Felicetti F, Bonci D, Addario A, Gallo P,    Bang M L, Segnalini P, Gu Y, Dalton N D, Elia L, Latronico M V,    Høydal M, Autore C, Russo M A, Dorn G W 2nd, Ellingsen O,    Ruiz-Lozano P, Peterson K L, Croce C M, Peschle C, Condorelli G:    MicroRNA-133 controls cardiac hypertrophy. Nat Med. 13:613-8, 2007-   53. Tatsuguchi M, Seok H Y, Callis T E, Thomson J M, Chen J F,    Newman M, Rojas M, Hammond S M, Wang D Z: Expression of microRNAs is    dynamically regulated during cardiomyocyte hypertrophy. J Mol Cell    Cardiol. 42:1137-41, 2007-   54. van Rooij E, Olson E N: MicroRNAs: powerful new regulators of    heart disease and provocative therapeutic targets. J Clin Invest.    117:2369-76, 2007-   55. Berezikov E, Guryev V, van de Belt J, Wienholds E, Plasterk R H,    Cuppen E: Phylogenetic shadowing and computational identification of    human microRNA genes. Cell. 120:21-4, 2005-   56. Bentwich I, Avniel A, Karov Y, Aharonov R, Gilad S, Barad O,    Barzilai A, Einat P, Einav U, Meiri E, Sharon E, Spector Y, Bentwich    Z: Identification of hundreds of conserved and nonconserved human    microRNAs. Nat Genet. 37:766-70, 2005-   57. Baskerville S, Bartel D P: Microarray profiling of microRNAs    reveals frequent coexpression with neighboring miRNAs and host    genes. RNA. 11:241-7, 2005-   58. Nagase T, Kikuno R, Ishikawa K, Hirosawa M, Ohara O: Prediction    of the coding sequences of unidentified human genes. XVII. The    complete sequences of 100 new cDNA clones from brain which code for    large proteins in vitro. DNA Res. 7:143-50, 2000-   59. Desjardins P R, Burkman J M, Shrager J B, Allmond L A, Stedman H    H: Evolutionary implications of three novel members of the human    sarcomeric myosin heavy chain gene family. Mol Biol Evol. 19:375-93,    2002-   60. Lefebvre V, Dumitriu B, Penzo-Méndez A, Han Y, Pallavi B:    Control of cell fate and differentiation by Sry-related    high-mobility-group box (Sox) transcription factors. Int J Biochem    Cell Biol. 39:2195-214, 2007-   61. Sinclair A H, Berta P, Palmer M S, Hawkins J R, Griffiths B L,    Smith M J, Foster J W, Frischauf A M, Lovell-Badge R, Goodfellow P    N: A gene from the human sex-determining region encodes a protein    with homology to a conserved DNA-binding motif. Nature. 346:240-4,    1990-   62. Gubbay J, Collignon J, Koopman P, Capel B, Economou A,    Münsterberg A, Vivian N, Goodfellow P, Lovell-Badge R: A gene    mapping to the sex-determining region of the mouse Y chromosome is a    member of a novel family of embryonically expressed genes. Nature.    346:245-50, 1990-   63. Graham V, Khudyakov J, Ellis P, Pevny L: SOX2 functions to    maintain neural progenitor identity. Neuron. 39:749-65, 2003-   64. Bylund M, Andersson E, Novitch B G, Muhr J: Vertebrate    neurogenesis is counteracted by Sox1-3 activity. Nat Neurosci.    6:1162-8, 2003-   65. Pevny L, Placzek M: SOX genes and neural progenitor identity.    Curr Opin Neurobiol. 15:7-13, 2005-   66. Wegner M, Stolt C C: From stem cells to neurons and glia: a    Soxist's view of neural development. Trends Neurosci. 28:583-8, 2005-   67. Pennisi D, Bowles J, Nagy A, Muscat G, Koopman P: Mice null for    sox18 are viable and display a mild coat defect. Mol Cell Biol.    20:9331-6, 2000-   68. Maka M, Stolt C C, Wegner M: Identification of Sox8 as a    modifier gene in a mouse model of Hirschsprung disease reveals    underlying molecular defect. Dev Biol. 277:155-69, 2005-   69. Wilson M E, Yang K Y, Kalousova A, Lau J, Kosaka Y, Lynn F C,    Wang J, Mrejen C, Episkopou V, Clevers H C, German M S: The HMG box    transcription factor Sox4 contributes to the development of the    endocrine pancreas. Diabetes. 54:3402-9, 2005-   70. Dewing P, Chiang C W, Sinchak K, Sim H, Fernagut P O, Kelly S,    Chesselet M F, Micevych P E, Albrecht K H, Harley V R, Vilain E:    Curr Biol. 16:415-20, 2006-   71. Matsui T, Kanai-Azuma M, Hara K, Matoba S, Hiramatsu R, Kawakami    H, Kurohmaru M, Koopman P, Kanai Y: Redundant roles of Sox17 and    Sox18 in postnatal angiogenesis in mice. J Cell Sci. 119:3513-26,    2006-   72. O'Donnell M, Hong C S, Huang X, Delnicki R J, Saint-Jeannet J P:    Functional analysis of Sox8 during neural crest development in    Xenopus. Development. 133:3817-26, 2006-   73. Bergsland M, Werme M, Malewicz M, Perlmann T, Muhr J: The    establishment of neuronal properties is controlled by Sox4 and    Sox11. Genes Dev. 20:3475-86, 2006-   74. Smits P, Li P, Mandel J, Zhang Z, Deng J M, Behringer R R, de    Crombrugghe B, Lefebvre V: The transcription factors L-Sox5 and Sox6    are essential for cartilage formation. Dev Cell. 1:277-90, 2001-   75. Yi Z, Cohen-Barak O, Hagiwara N, Kingsley P D, Fuchs D A,    Erickson D T, Epner E M, Palis J, Brilliant M H: Sox6 directly    silences epsilon globin expression in definitive erythropoiesis.    PLoS Genet. 2:e14, 2006-   76. Dumitriu B, Patrick M R, Petschek J P, Cherukuri S, Klingmuller    U, Fox P L, Lefebvre V: Sox6 cell-autonomously stimulates erythroid    cell survival, proliferation, and terminal maturation and is thereby    an important enhancer of definitive erythropoiesis during mouse    development. Blood. 108:1198-207, 2006-   77. Stolt C C, Schlierf A, Lommes P, Hillgärtner S, Werner T, Kosian    T, Sock E, Kessaris N, Richardson W D, Lefebvre V, Wegner M: SoxD    proteins influence multiple stages of oligodendrocyte development    and modulate SoxE protein function. Dev Cell. 11:697-709, 2006-   78. Hagiwara N, Klewer S E, Samson R A, Erickson D T, Lyon M F,    Brilliant M H: Sox6 is a candidate gene for p100H myopathy, heart    block, and sudden neonatal death. Proc Natl Acad Sci USA. 97:4180-5,    2000-   79. Cohen-Barak O, Yi Z, Hagiwara N, Monzen K, Komuro I, Brilliant M    H: Sox6 regulation of cardiac myocyte development. Nucleic Acids    Res. 31:5941-8, 2003-   80. Tsukahara K, Yamamoto H, Okayama H: An RNA binding protein    negatively controlling differentiation in fission yeast. Mol Cell    Biol. 18:4488-98, 1998-   81. Yamamoto H, Tsukahara K, Kanaoka Y, Jinno S, Okayama H:    Isolation of a mammalian homologue of a fission yeast    differentiation regulator. Mol Cell Biol. 19:3829-41, 1999-   82. Hosoda T, Bearzi C, Yasuzawa-Amano S, Amano K, Cheng W, Rota M,    Kajstura J, Anversa P, Leri A: Genetic marking of human cardiac stem    cells. Submitted, 2008-   83. Davidson J S, Baumgarten I M, Harley E H: Reversible inhibition    of intercellular junctional communication by glycyrrhetinic acid.    Biochem Biophys Res Commun. 134:29-36, 1986.-   84. Takeda Y, Ward S M, Sanders K M, Koh S D: Effects of the gap    junction blocker glycyrrhetinic acid on gastrointestinal smooth    muscle cells. Am J Physiol Gastrointest Liver Physiol. 288:G832-41,    2005-   85. Perez-Alcala S, Nieto M A, Barbas J A: LSox5 regulates RhoB    expression in the neural tube and promotes generation of the neural    crest. Development. 131:4455-65, 2004-   86. Melichar H J, Narayan K, Der S D, Hiraoka Y, Gardiol N, Jeannet    G, Held W, Chambers C A, Kang J: Regulation of gammadelta versus    alphabeta T lymphocyte differentiation by the transcription factor    SOX13. Science. 315:230-3, 2007-   87. Lai T, Jabaudon D, Molyneaux B J, Azim E, Arlotta P, Menezes J    R, Macklis J D: SOX5 Controls the Sequential Generation of Distinct    Corticofugal Neuron Subtypes. Neuron. 57:232-247, 2008-   88. Dunn T L, Mynett-Johnson L, Wright E M, Hosking B M, Koopman P    A, Muscat G E: Sequence and expression of Sox-18 encoding a new    HMG-box transcription factor. Gene. 161:223-5, 1995-   89. Zhang C, Basta T, Klymkowsky M W: SOX7 and SOX18 are essential    for cardiogenesis in Xenopus. Dev Dyn. 234:878-91, 2005-   90. Sakamoto Y, Hara K, Kanai-Azuma M, Matsui T, Miura Y, Tsunekawa    N, Kurohmaru M, Saijoh Y, Koopman P, Kanai Y: Redundant roles of    Sox17 and Sox18 in early cardiovascular development of mouse    embryos. Biochem Biophys Res Commun. 360:539-44, 2007-   91. Liu Y, Asakura M, Inoue H, Nakamura T, Sano M, Niu Z, Chen M,    Schwartz R J, Schneider M D: Sox17 is essential for the    specification of cardiac mesoderm in embryonic stem cells. Proc Natl    Acad Sci USA. 104:3859-64, 2007-   92. Rota M, Kajstura J, Hosoda T, Bearzi C, Vitale S, Esposito G,    Iaffaldano G, Padin-Iruegas M E, Gonzalez A, Rizzi R, Small N,    Muraski J, Alvarez R, Chen X, Urbanek K, Bolli R, Houser S R, Leri    A, Sussman M A, Anversa P: Bone marrow cells adopt the    cardiomyogenic fate in vivo. Proc Natl Acad Sci USA. 104:17783-8,    2007a-   93. Vinken M, Vanhaecke T, Papeleu P, Snykers S, Henkens T, Rogiers    V: Connexins and their channels in cell growth and cell death. Cell    Signal. 18:592-600, 2006-   94. Hervé J C, Bourmeyster N, Sarrouilhe D, Duffy H S: Gap    junctional complexes: from partners to functions. Prog Biophys Mol    Biol. 94:29-65, 2007-   95. Me    e G, Richard G, White T W: Gap junctions: basic structure and    function. J Invest Dermatol. 127:2516-24, 2007-   96. Cancelas J A, Koevoet W L, de Koning A E, Mayen A E, Rombouts E    J, Ploemacher R E: Connexin-43 gap junctions are involved in    multiconnexin-expressing stromal support of hemopoietic progenitors    and stem cells. Blood. 96:498-505, 2000-   97. Montecino-Rodriguez E, Dorshkind K: Regulation of hematopoiesis    by gap junction-mediated intercellular communication. J Leukoc Biol.    70:341-7, 2001-   98. Rosendaal M, Jopling C: Hematopoietic capacity of connexin 43    wild-type and knock-out fetal liver cells not different on wild-type    stroma. Blood. 101:2996-8, 2003-   99. Huettner J E, Lu A, Qu Y, Wu Y, Kim M, McDonald J W: Gap    junctions and connexon hemichannels in human embryonic stem cells.    Stem Cells. 24:1654-67, 2006-   100. Willert K, Brown J D, Danenberg E, Duncan A W, Weissman I L,    Reya T, Yates J R 3rd, Nusse R: Wnt proteins are lipid-modified and    can act as stem cell growth factors. Nature. 423:448-52, 2003-   101. Nusse R: Wnts and Hedgehogs: lipid-modified proteins and    similarities in signaling mechanisms at the cell surface.    Development. 130:5297-305, 2003-   102. Wang H Y, Malbon C C: Wnt signaling, Ca2+, and cyclic GMP:    visualizing Frizzled functions. Science. 300:1529-30, 2003-   103. Fujino T, Asaba H, Kang M J, Ikeda Y, Sone H, Takada S, Kim D    H, Ioka R X, Ono M, Tomoyori H, Okubo M, Murase T, Kamataki A,    Yamamoto J, Magoori K, Takahashi S, Miyamoto Y, Oishi H, Nose M,    Okazaki M, Usui S, Imaizumi K, Yanagisawa M, Sakai J, Yamamoto T T:    Low-density lipoprotein receptor-related protein 5 (LRP5) is    essential for normal cholesterol metabolism and glucose-induced    insulin secretion. Proc Natl Acad Sci USA. 100:229-34, 2003-   104. Daniels D L, Eklof Spink K, Weis W I: beta-catenin: molecular    plasticity and drug design. Trends Biochem Sci. 26:672-8, 2001-   105. Gottardi C J, Gumbiner B M: Adhesion signaling: how    beta-catenin interacts with its partners. Curr Biol. 11:R792-4, 2001-   106. Huber O, Korn R, McLaughlin J, Ohsugi M, Herrmann B G, Kemler    R: Nuclear localization of beta-catenin by interaction with    transcription factor LEF-1. Mech Dev. 59:3-10, 1996-   107. Hsu S C, Galceran J, Grosschedl R: Modulation of    transcriptional regulation by LEF-1 in response to Wnt-1 signaling    and association with beta-catenin. Mol Cell Biol. 18:4807-18, 1998-   108. Novak A, Dedhar S: Signaling through beta-catenin and Lef/Tcf.    Cell Mol Life Sci. 56:523-37, 1999-   109. Naito A T, Shiojima I, Akazawa H, Hidaka K, Morisaki T, Kikuchi    A, Komuro I: Developmental stage-specific biphasic roles of    Wnt/beta-catenin signaling in cardiomyogenesis and hematopoiesis.    Proc Natl Acad Sci USA. 103:19812-7, 2006-   110. Kwon C, Arnold J, Hsiao E C, Taketo M M, Conklin B R,    Srivastava D: Canonical Wnt signaling is a positive regulator of    mammalian cardiac progenitors. Proc Natl Acad Sci USA. 104:10894-9,    2007-   111. Nakamura T, Sano M, Songyang Z, Schneider M D: A Wnt- and    beta-catenin-dependent pathway for mammalian cardiac myogenesis.    Proc Natl Acad Sci USA. 100:5834-9, 2003-   112. Koyanagi M, Haendeler J, Badorff C, Brandes R P, Hoffmann J,    Pandur P, Zeiher A M, Kühl M, Dimmeler S: Non-canonical Wnt    signaling enhances differentiation of human circulating progenitor    cells to cardiomyogenic cells. J Biol Chem. 280:16838-42, 2005-   113. Koyanagi M, Bushoven P, Iwasaki M, Urbich C, Zeiher A M,    Dimmeler S: Notch signaling contributes to the expression of cardiac    markers in human circulating progenitor cells. Circ Res.    101:1139-45, 2007-   114. Rota M, LeCapitaine N, Hosoda T, Boni A, De Angelis A,    Padin-Iruegas M E, Esposito G, Vitale S, Urbanek K, Casarsa C,    Giorgio M, Lüscher T F, Pelicci P G, Anversa P, Leri A, Kajstura J:    Diabetes promotes cardiac stem cell aging and heart failure, which    are prevented by deletion of the p66shc gene. Circ Res. 99:42-52,    2006-   115. Boni A, Nascimbene A, Urbanek K, Delucchi F, Gonzalez A,    Siggins R, Amano K, Yasuzawa-Amano S, Ojaimi C, Rota M, Hosoda T,    Anversa P, Kajstura J, Leri A: Notch1 receptor enhances myocyte    differentiation of cardiac progenitor cells and myocardial    regeneration after infarction. Submitted, 2008.-   116. Gonzalez A, Rota M, Nurzynska D, Misao Y, Tillmanns J, Ojaimi    C, Padin-Iruegas M E, Müller P, Esposito G, Bearzi C, Vitale S, Dawn    B, Math S, Baker M, Hintze T H, Bolli R, Urbanek K, Hosoda T,    Anversa P, Kajstura J, Leri A: Activation of Cardiac Progenitor    Cells Reverses the Failing Heart Senescent Phenotype and Prolongs    Lifespan. Circ Res. 102: 597-606, 2008.-   117. Sinner D, Rankin S, Lee M, Zorn A M: Sox17 and beta-catenin    cooperate to regulate the transcription of endodermal genes.    Development. 131:3069-80, 2004-   118. Related Articles, Links Wallenstein S, Zucker C L, Fleiss J L:    Some statistical methods useful in circulation research. Circ Res.    47:1-9, 1980-   119. Berenson M L, Levine D M, Rindskopf D: Applied statistics.    Prentice Hall, Englewood Cliffs. 362-418, 1988-   120. Rota M, Hosoda T, De Angelis A, Arcarese M L, Esposito G, Rizzi    R, Tillmanns J, Tugal D, Musso E, Rimoldi O, Bearzi C, Urbanek K,    Anversa P, Leri A, Kajstura J: The young mouse heart is composed of    myocytes heterogeneous in age and function. Circ Res. 101:387-99,    2007b-   121. Tillmanns J, Rota M, Hosoda T, Misao Y, Esposito G, Gonzalez A,    Vitale S, Parolin C, Yasuzawa-Amano S, Muraski J, De Angelis A,    Lecapitaine N, Siggins R W, Loredo M, Bearzi C, Bolli R, Urbanek K,    Leri A, Kajstura J, Anversa P: Formation of large coronary arteries    by cardiac progenitor cells. Proc Natl Acad Sci USA. 105:1668-73,    2008

1. A pharmaceutical composition comprising cardiac stem cells and a pharmaceutically acceptable carrier, wherein said cardiac stem cells comprise a transgene.
 2. The composition of claim 1, wherein said transgene encodes a microRNA.
 3. The composition of claim 2, wherein said microRNA is miR-499.
 4. The composition of claim 1, wherein said transgene encodes an inhibitory RNA molecule.
 5. The composition of claim 4, wherein said inhibitory RNA molecule targets a polynucleotide sequence encoding a protein selected from the group consisting of Sox5, Sox6 and Rod1.
 6. The composition of claim 1, wherein said transgene is expressed from a vector comprising a promoter operably linked to said transgene.
 7. The composition of claim 6, wherein said promoter is an inducible promoter.
 8. The composition of claim 6, wherein said vector is a lentiviral vector.
 9. The composition of claim 1, wherein said cardiac stem cells are human cardiac stem cells.
 10. The composition of claim 1, wherein said cardiac stem cells are c-kit positive.
 11. The composition of claim 1, further comprising vascular progenitor cells.
 12. A method for regenerating damaged myocardium in a subject in need thereof comprising: administering a pharmaceutical composition of claim 1 to an area of damaged myocardium in the subject, wherein said cardiac stem cells differentiate into mature, functional cardiomyocytes following administration, thereby regenerating the damaged myocardium.
 13. The method of claim 12, wherein the regenerated myocardium exhibits the functional characteristics of adult myocardium.
 14. The method of claim 12, wherein said cardiac stem cells are autologous.
 15. The method of claim 12, wherein said composition is administered to the border zone of the damaged myocardium.
 16. The method of claim 12, wherein said composition is administered by an intramyocardial injection.
 17. The method of claim 12, wherein said composition is administered by a catheter system.
 18. The method of claim 12, wherein the subject is suffering from a myocardial infarction.
 19. A method for regenerating damaged myocardium in a subject in need thereof comprising: (a) extracting cardiac stem cells from the subject; (b) incorporating a transgene into said extracted cardiac stem cells, wherein said transgene encodes a microRNA; and (c) administering the cardiac stem cells from step (b) to an area of damaged myocardium in the subject, wherein the cardiac stem cells differentiate into mature, functional cardiomyocytes following administration, thereby regenerating the damaged myocardium.
 20. The method of claim 19, wherein said microRNA is miR-499.
 21. The method of claim 19, wherein extracting cardiac stem cells from the subject comprises harvesting myocardial tissue from the subject and isolating the cardiac stem cells from said myocardial tissue.
 22. The method of claim 19, wherein the cardiac stem cells are c-kit positive.
 23. The method of claim 19, wherein said microRNA is overexpressed in said cardiac stem cells.
 24. The method of claim 19, further comprising administering vascular progenitor cells to an area of damaged myocardium in the subject, wherein the vascular progenitor cells are autologous.
 25. The method of claim 24, wherein at least some of the vascular progenitor cells differentiate into endothelial cells and smooth muscle cells, thereby generating new vascular structures.
 26. The method of claim 19, wherein said subject is human.
 27. A method for regenerating damaged myocardium in a subject in need thereof comprising: (a) administering cardiac stem cells to an area of damaged myocardium in the subject, wherein the cardiac stem cells differentiate into myocytes, smooth muscle cells, and endothelial cells after their administration, thereby regenerating the damaged myocardium; and (b) administering a transgene encoding a microRNA to the area of regenerated myocardium, wherein the regenerated myocardium exhibits the functional characteristics of adult myocardium following transgene administration.
 28. The method of claim 27, wherein said microRNA is miR-499.
 29. The method of claim 27, wherein said transgene is administered by providing a vector encoding said transgene.
 30. The method of claim 27, wherein the cardiac stem cells are c-kit positive.
 31. The method of claim 27, wherein the cardiac stem cells are autologous. 